HomeMy WebLinkAbout0099 POND VIEW DRIVE - Health 99 Pond View Drive
Centerville
A=229-025
Ill �
UPC 12543
No.53„LOR `�srco
HASTINGS, MN
TOWN OF BARNSTABLE
LOCATION 075 �a� y�xa,•_ 17 _ SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL of a I .Z S
INSTALLER'S NAME&PHONE NO. f';_0 8 191 0530
SEPTIC TANK CAPACITY /S UCH
LEACHING FACILITY:(type) 3-S-60, �M C4 a (size) � X &.2 X
� v
NO.OF BEDROOMS
OWNER 2 �[ .2il
PERMIT DATE: ; COMPLIANCE DATE: 0 3 1//
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,)/✓9 IY19 • Feet
FURNISHED BY 0&/t"A-t_ t
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5" Ao..x c,LL "yid u 5 c
TOWN Of BARNSTABLE
LOCATION i✓6 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT -2`7-
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS .3 m /J� r�
B�DER� R R OWNER 1I 4 /j 40—J(
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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) X,0 n/l� 'Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
�S�/'��'�i�o1✓ J�f%f�,✓� � Jug�,�g�
II i3�ii✓��,✓ G �O�ss y�ooG•S
HNC �i/4A�zff%PA/Li or lloceJ
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No. � Fee /oo.
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS YeS
2pplitation for Misposal *pstrm ConstCUttiott Prrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. q') POO ,k V i o 1 ik w Owner's Name,Address,and Tel.No. 5 a F- �XS- ;2 3 G s`
Assessor's Map/Par % 1 ft1Z .e v-T_ M 4 chi i o r-d
Ins Nam ddr s, d Tel Designer's Name,Address,and Tel.No. 501` 3Ga- ?f 7.1
l CAA Vg,,4 .f N C.
Type of Building:
Dwelling No.of Bedrooms Lot Size o?S� 33® sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) '3 U gpd Design flow provided 413� gpd
Plan Date )�.?/�f/ Number of sheets i Revision Date
Title
Size of Septic Tank /,fv D Type of S.A.S. F/o cv d,r!',j
Description of Soil ILp �2 cX.t,uv� 5 uucYa
Nature of Repairs or Alterations(Answer when applicable)
/S U C> ry�.(,Q�,.. L / - l7 3 NI 20 l] i� o x 3 L fK a�. X of.20 Flo w -0
---
W i t 4/ S fi,vi.c %v�a
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and mainZnot�
f the afor escribed on-site sewage disposal system in
accordance with the provisions of Title 5 of the E - nmental Co pla the system in operation until a Certificate of
Compliance has been issued by this Board o eal
Signed Date
Application Approved by Date
Application Disapprove y Date
for the following reasons
Permit No. �01 I Z Z Date Issued 7 I3 / 1
-
iT
4 } 4,
/
+ {,. No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: 1011,
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zfpplicatioi Y for MisposaY 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade O Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. q g Pcsvt cQ V r EW fa� Owner's Name,Address,and Tel.No. S`U�• '�,?S= a?3 G S
Assessor's Map Parce a
Install�lNamZXdddd/ress and T/e1,No!� Designer's Name,,Address,and Tel.No. ���/ - 3Ga- $( 34
CrType of Building:
V
Dwelling No.of Bedrooms Lot Size 451 33 O sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
rp
Other Fixtures ,
Design Flow(min,yequired) 'j U gpd Design flow provided jt3 Ma gpd
Plan Date 4? Number of sheets Revision Date
Title
i
Size of Septic Tank /1 v O Type of S.A.S.
r
Description of Soil yLj _e
i
i
i
Nature of Repairs or Alterations Answer when applicable) &7, (' f
/J
/VSca f �� !� �cJ IZ a +l L na0
tL
b
Date last inspected: i
Agreement:
-,The undersigned agrees to ensure the construction and maintenance of the af�o'rwdescribed on-site sewage disposal system in
accordance with the provisions of Title 5 of the
vironmental Code ai id no place'the system in operation until a Certificate of
Compliance has been issued by this Board of'Healt4.
Signed Date
Application Approved by - Date
Application Disapprove y Date
for the following reasons
f
Permit No. 20 11 Z_�Z Date Issued 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 20�, y.. 0 C"o WL c .
at I?r( has been constructed in accordance
with the provisions f /s o Title S�.and h f —
r 1 the or Disposal System Construction Permit No�/�� �?jZ dated �� 3 1
Installer Designer
#bedrooms Approved design flow 330, "" gpd
The issuance of this permit sh 1//not be construed as a guarantee that the system wilM c•io r esigned.
Date `�11,311 Inspector E
No.ZOO/— Z 3 Z_ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Misposal bpstem Construction 3permit
Permission is hereby granted to Construct( ) Repair(c/) Upgrade( ) Abandon( )
System located at 19 5 /'(G�� 0,;e a 7J,v -t
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:Co struction must be completed within three years of the date of this permit. ,.-_�
Date /3 "�/ Approved by ( --
Town of Barnstable
�FTME Tp�
Regulatory Services
* Thomas V. Geller Di
i rt BARNSTABLE, * f Director
MASS.63
i639• Public Health Division
�3 ,��
AlF°MrsA Thomas McKean, Director
200.Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: /b Sewage Permit# (Oft- Assessor's Map\Parcel 2 b2,<—
Designer: �i /� • �o pE Installer:
Address: -12 3 J2-0V7Z— Address:
On i. was issued a permit to install a
(date) (installer)
septic system at t Pa,w b V 1 1::,C-3 bl— based on a design drawn by
(address)
I'"VtS, A eE- dated
/ (designer)
I certify that the septic system referenced above was installed substantial) according to
the design, y g
which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic stem) in accordance with State & Local Regulations. Plan revision or
certified -built by resigner to follow.
> 91,
STEPH .,
sWIMtr Signature)
No 35461
Any
(De-signer'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:\Septic\Designer Certification Form Revised.doc
Town of Barnstable P#
Department of Health,Safety,and Environmental Services 1
Public Health Division Date
367 Main Street,HyaannnisVA 03601
BARNSTABM
/
y MASS. $ / ///
�ATED �k Date Scheduled Time Bee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: A n W itnessed B �D q� t
LQCATTQN& GENERAL INFORMATION
Location Address D Owner's Name
Cr -v� c L� t�Ac uv,zb�
Address
Assessor's Map/Parcel: 2_2<J /02!�— Engineer's Name � pE
NEW CONSTRUCTION REPAIR X Telephone ft Soo '367 14 .91
Land Use Slo es
p O Surface Stones AjQ
Distances from: Open Water Body ft Possible Wet Area "°"` ft Drinking Water Well ®"` ft
Drainage Way ft Property Line /y t ft Other ft
SKETCH: (Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
a
Y
A
.Ex13rIRa THREE
REORddu OWEte W.*: i
RAX
12* ENr
/led CA[LdN
Sepr'C T4,YM1' .p y
J-1•r d.
j' RdX 4 SOVr 4AOOND USORS
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� �, 3't':0\' `;f�\ ! `Pi`7 °54'30•E :� caidH PNO
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p.0ND VIEPV DRIVE
Parent material(geologic) P4,04 e..AC e 4 e. 41/rLLdA-Y 4-1 Depth to Bedrock c.)
Depth to Groundwater: Standing Water in Hole: I.-L.,Q a, Weeping from Pit Face
Estimates Seasonal High Groundwater
q.
DTERIYIINATI�II FAR SEASONAT HIGH WATER TBLIt�
Method Used. A_)d/J E7
Depth Observed standing in obs.hole: in. Depth to.soil mottles: in.
Depth to weeping from side of o s.hole: in. Groundwater Adjustment $,
Tndex Well#t4tlBJ. Reading Date: 5� 11_ Index Well level Adj.factor Z_r Adj.Groundwater Level
PERCOLATIiflN TEST Date �� rime '
Observation
Hole# Time at 9"
Depth of Pere. Time at 6"
Start Pre-soak Time @ �•7=1�'
Time(9"-6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed L'O Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back j
Copy:.. Applicant
DEEP OB.SE+Ri �IOTI(? t HOC Tole:#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,% ra e
w GIBSERVATi(JN HOLE LQG H.oIe#: �: :
Depth from Soil Horizon Soil Texture Soil Color "Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
°° vel
0 YR Sly C, 41
:DEEP QBURVA-T-!0f T HOLE L Q
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Con 'stenc %Gravel
DEEP bBSERVATION HOL LO.G Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.° Gravel)
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? 11-5 _
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on !� ► S�. (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 training, a ertise and experience described in 310 CMR 15.017.
Signature _ Date 7 Z-a®l
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ACCESS OVER WI ETCS kUST BE THIN *
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CHARC ./ NVOAL r ER T EL E 1A T / ONS . DES / GN CR / TER 1A6', OF FINISH GRADE .1 , GENERA L No
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OVER RO J* -MAXIMUk COVER I..11 - , CBUGHT TO
� I'. FILTER INVERT AT BUI 99.72LDING101.72 DESIGN FLOW:
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GRADE IN DR VE4 IIWY MIN 6FEAI 2 PSTONE l
.�� .INVERTN SPI TANK: 96,B5 J BEDROOMS AT I. THIS PLAN IS FOR THE DESIG- BE LEVEL ,ll II0 .G.P.D. PER NAND CONSTRUCTION
-" ORFTE ABCLR�FRI i6'MIN BEDROOM EQUAL OF THE DISPOSAL SYSTEM ONLY. INVERT--OUT SEPTIC TANK: 98.6 P
4- IDIAM ft 964., INVERT IN DI$T. BOX: . 7 _ . - ..,
9 98Ii INVERT OUT DIST. BOX: 11 98,J NO GARBAGE GRINDER 4. VERTICAL DATUM-15,AS$UMED, FOR BENCH MARKS
I/ %jH.26
; , 6AS � SET ,SEE �SITE PLAN. ,'
. '' r , � 14 - I 1 f . � 98.I12 INVERT IN LEACH CHAMBER: 98. 12
-2 , BAFFLE t"
-
- SEPTIC TANK REQUIRED:
WASHED STONE
. , , v 97.2 I I J-4 BOTTOM OF.LEACH CHAMBER:j OUTLET. ,8 FLOWDIFFUSORS . � . 660 GAL. J. ALL iCONSTRUCTION METHODS AND MATERfALS AND 1,
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I 1500 GAL ' � SEPTIC TANK PROVIDED: 1500 CAL. MIN. MAINTENANCE' OFTHE SEPTIC SYSTEM SHALL
, H-20 � 1 - OBSERV GROUN WE : NIA
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I I SEPTIC TANK COOR TO kASS., D.E P. TITLE�5AND LOCAL
� 1. 11 , BOTTOM OF TEST HOLE */ 89.7 - I
' S TION SYSTEM REOUIRED: BOARD OF HEALTH REGULATIONS. -6CRUSHED-STONE OR- , zi -
INDEX WELL 41W 29. ZONED DESIGN PERORATE ( 5 MIN/INCH 4
COMPACTED BASE` � - . .
: - 30,�. 0 MAY 2011 READING-7.2 . ADJ-2.5 SOIL TEXTURAL CLASS I 4. ALL SEPTIC SYSTEM COMPONENTS &NDER'- , '1 I...
&/ - F - AREAS SUBJECT TOVEHICULAR TRAFFIC OR 'GREATERPR OF L E :,NOT TO SCALE -. kA - I EFLUENT LOADING RATE 0.74 ,GPDISF
I � 330 GPD / 0.74 PD THAN
IJ*, IN DEPTH SHALL. BE-CAPABLE 'OF WITH- .
A G RED .; - STANDING H-20 WHEEL.LOADS.
- N PROVIDED: 3-4'X 8' FLOWDIFFUSORS
1 ,
W14* STONE AROUND. A-465.S.F. 5. . ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 1
. S.F. x 0.74 .- 343 G.P.D. APPROVED EOUAL. '465
" LIOT 7A -
. 6 PTC'
S I TANK AND 0-BOX SHALL BE REINFORCED
25. 330± S.F. SOIL TEST P 1 T DA TA PRECAST CONCRETE OR APPROVED POLYETHYLENE.I
BOTH.SHALL BE WATERTIGHT. D-BOX SHALL 'BE WATER
U A � INDICATES INDICATES - .
. =" OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE
104 - . TEST GROUNDWATER
- 1. -OUTL ET
CESSPOOL - -
a -
II . I 0
—, . . - TP #1 p " l5tbe- TP *2
. 0 - 7. BEFORE CONSTRUCTION CALL 'DIG-SAPE
.
1. i , OR 1-868-DIG-SOE AND THE LOCAC WATER DEPT.;�
IZON TEXTURE COLOR COLOR
11 4 O* IO/.O O' 10/.0 - FOR LOCATION OF UNDERGROUND UTILITIES.:.
- LOAMY IOYR LOAMY ' IOYR 1 .
- A � . 1
SAND 414 A SAND 414 .
1 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY-THE12 ... . ................ . ........ - 100.0 10 - ............ . ..................... - 100.2
I - DESIGN ENGINEER DAYS PRIOR ,TO-CONS-TRUCTION
1 .1 I 101.4 . LOAMY IOYR LOAMY IOYR I -B B �
HREE OF THE' SYSTEM TO ALLOW FOR SCHEDULING OF THE
ST I"OTING . SAND 416SAND 4/6
,EX 6WELL -
, M .........4. .......... ......... ... CONSTRUCTION,INSPECTIONS.
BEDRO 12 . 30
- 0I. 98.5
- 1 -
TOF D -. -0 ,I MEDIUM I OYR MEDIUM IOY. * - R c C
, t �0 16' SAND 518 SAND 518 9. EXISTING CESSPOOLS TO BE DRY AND I �.,
- BACKFILLED.
. .
--' ' ' VENT.
s I I ,/O. EXISTING INVERT AT THE REAR OF THE DWELLING TO.:. 3-4.x 8' FLORDIFFUSORS 50
- am. CORR STOOP 12 :: •, . F14* STONE AROUND BE REROUTED TO THE EXISTING FRONT OUTLET. �
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SEPTIC TANK D #Ox -" , .
CESSPOO -,I 1
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1:� ;
YL ,' CEDAR NO WATER NO WATER
.� 910, 89 7 120 I. ... I-
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.- "I I . II% I �- DA TE: JUNE 7. 2011 .
1 TEST BY: STEPHEN HAAS.
I W1CO's � I TNESSED BY: ,DONALD DESkARAIS .
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0 ,� PERC RATE: ( 2,MINIINCH
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MAPLE - . I , - '� � ,F ,- ,A-130 k;� o , -4 "''y" I . -, .-
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T-7 UNDERGROUND TELEPHONE L INE 11 1 8 Z 6 2 1' 2 1. 1, - / 1 I (,I , , '
. c UNDERGRO 1 TV UND CABLEVISION LINE 6 0 e 4 3 1 �3 3� 1 .1
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