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HomeMy WebLinkAbout0143 SACHEM DRIVE - Health 143 Sachem Drive 17 Centerville, MA A=229— 105 { I< P fe ! a AN UPC 12534 0.2.153LQ e 1' t E TOWN OF BAMSTABLE LOCATION 1 '0 S A C H e M I9 A SEWAGE # —)C)C7S VILLAGE C e A/I e R V r Z L e ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. In A C O A Al SEPTIC TANK CAPACITY �•S® o . LEACHING FACILITY: (type) W eLl5 (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: 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 d7G P I a+ s � 1 I yoga PJ No,i9W 5 2-5, Fee D� 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication for Mi$pO.5al *p5tem Cow6truction hermit Application for a Permit to Construct( . )Repair() j Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ��`, Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's NamS,�A�dddrress,and Tel Nool. Designer's Name AAd�d�ress and Tel.Noce kk 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 gallons per day. Calculated daily flow 91 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank I GO 40 Type of S.A.S. D"So40 C�1 QI�n C PxS Description of Soil Natur of Repairs rAlterations(Answer when applicable) dVl �� W! I ©� Quo is 1 i b uho n O l 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 Certifi- cate of Compliance has been is o of It Sign ` Date Application Approved by Date Application Disapproved for the following reasons Permit No. 61603 Date Issued Fee VsITHE COMMCrIv'kXl TH OF MASSACHUSETTS Entered in computer:.4, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Rpprication for Mioont *vaem Conotruction Permit Application for a Permit to Construct( )Repair(1\)Upgrade( )Abandon( ) O Complete System D Individual Components Location Address or Lot No.M3 & Owner's Name,Address and Tel.No. Assessor's Map/Parcel T1 -02'm h� Installer's Name,Address,and Tel.No. S�`9 33 fb Designer's Name,Address and Tel.N(�w --Vqu- P(D 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 gallons per day. Calculated daily flow �5 ` gallons. Plan Date Number of sheets Revision Date Title --` Size of Septic Tank 1 0 Q � Type of S.A.S. G90 Lead'im CjM—[,W { Description of Soil; _- - Nature of Repairs or Alterations(Answer hen applicable) V'�1 �' -( oc) G� D G �W n — n 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 Certifi- cate of Compliance has been issued-b.-his Bo d9of H®altfi. Sign•d r Date Application Approved by�. Date Application Disapproved for the following reasons Permit No. .'S �n Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS ce(rtificate's;of (Compliance {� THIS IS TO CE TIFY that the O =site Sewage Dig p osa1-Sy"tem C nstructed Repaired Upgraded Abandoned( )by - at 1 _ A has been constructed in accordance with the p ovisions of Title 5 and the for Disposal System Construction Permit No. fi� 5 lD dated Installer�abt r+ ?n-n t 41 % Designer � The issuance of this permit shall not be construed as a guarantee - - th�th esystewi union asesigned. Date Inspecto ------------ — ------------- No. 9X5 3 ` G ----- Fee/Da THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi$po5al *p2;tem Con$tructiion Permit Permission is hereby granted to Construct( )Repair Upgrade( bandon( ) System located at 1 10 )I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be I ompleted within three years of the date of this p Date:_ � Approved by 9116103 I ` Notice: This Form Is To Be Used For the Repair-Of Failed Septic Systems Only . PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM L 1 (k y� M. hereby certify that the engineered plan signed by me dated 71 ' 10.10r concerning the property located at meets. . all .of the. following criteria: • 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. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • 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 GLS information) 4S B) G.W.Elevation +adjustment for high G.W. _ A NO vi D CE BETWEEN A and B IL SIGNED:D DATE: 1. . ..v . NOTICE Based upon the above information;a repair permit will be issued for bedrooms "i maximum_ No additional bedrooms are authorized in the fuhire without engineered gin septic system plans. gASeptic\percexemp_doc Town.of Barnstable Regulatory Services h�P T Thomas F. Geiler,Director • SARNSIABLE. i XAS& a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Installer: �s Address: Address: � �{ C,,S�Oryk#- All+ 2&3 T ff , • On gcls,�+ \CI.U'l was issued a permit to install a (date) ,+ (installer) septic system at r T3 based on a design drawn by G /� `� `te (address) /k�QA A4. l'v r/ dated �! 1 o (designer) I certify that the septic stem referenced above was installed substantially P Y according to the design, 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 system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. H OF Af4 DARREN / M. (Inst� _1 s ignature) 1 4 N STERN" SqN/?ARIAN �b (Designer's Signature) Affix Designer's Stamp Here) PLEASE RETURN TO BARNS ABLE 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 V of � NOTES: o ASSESSORS MAP : 0 lr � � _ � � TEST. HOLE LOGS 9 ���9p�P90 3 v A PARCEL : W J 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH 9oF 00 �A "SOIL EVALUATOR : D. NC4e{ �S C�E HIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE : I� -T £ WITNESS : OT !' UI�d �R-�JSTA'f�1-G BOARD OF HEALTH REGULATIONS. d� 3 11,, v a O D REFERENCE : �F-- �33� DATE: ul 9j - GM5 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, M PERCOLATIO RATE: Z- M1� Ir1�,{� In SOILs SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO � � goo U-ss r o f t,� LTf1'(Z = 0,�y �Pd/ v INSTALLATION. Q P KRos TH- I �( _ qg, D I, TH-2 �[, .� 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION Li ong w sutusx-j � v�'1 LU ff M O ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE 4 Pont A '-' � �u 5 (01 �� a t� .SA-N f� 2i ° DETERMINATION. DR f � �Y '— piNE �;��q�,.j G•� L�-Nh BYE' 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS 2-3 lu 1. (.U� y �b � SPECIFIED OTHERWISE) . ,S. S � T /4 i/ 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A LOCATION MAP 2� 4q • Z5 GARBAGE DISPOSAL. Mi"" 4t 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C C . A'T 2 _0 MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON 7 A BASE OF 6"OF CRUSHED STONE. 7.) ��P�17rv6 144" Alb w F �L o _ P �- �-n-� _ZZ nL ke VA,/(L E4� �► b_Sip �04vv 06Scvk+q p651-KU D 6 WET-LA JVX-7 w/ I'�J f5U1 of P9-0P- LC- l I SEPT I C SYSTEM DES I GN o _r.nlorv�J ppV w u�i t►� !?�Io 12aP (,FA ►► . 10) V-(-1 0&0 fl�-W 1 -P T� V N, Tvw tJ of, FLOW ES3IMATE p� BEDROOMS AT IJO GAL/DAY/BEDROOM - 77OGAL/DAY SEPTIC TANK 3�GAL/DAY x 2 DAYS - GAL Z USE GALLON SEPT I C TANK- IVEP J 161.10 5 52� - ' SOIL ABSORPTION SYSTEM 15 rf j \ �_ i � ; �2-� Sib C.� �'t,LOnl P GA i ACH-!►jC d LOT 4 i \ R P �� , �?�' ice!"' F 2 I � AREA - 244001{ .- \ -- • \ I� \ ' - 1 SIDE 'AREA: Zr'1 Z- I Z x Z k �,7 2• Y8 o •� I\ i i I�- BOTTOM AREA: Z5 ,x I x j) 7 L _ 2- p , SO`� OGA -GATE\ ID J ZA WATE 1 i ( / O \ 1 •� 7 3 CY(p�� Y D o SEPT I C SYSTEM SECTION 9,,/ d m U-, ' ,o zC) (0ve" TU „MIN 'U � �I 7 J� MARK Q I O ( 13 II (aks gAFFt�r 15, jo BENCH � USTOP OF PK NAIL / 1 �L,ELEVATION - 48.03 C �3 _1 ' �3USGS DATUM ASSUMED i pRIVEWAY GAL _ D-BOX PAVED I ) I't °sf s! 52 SEPTC TANK { l4eu �LI, DoV�le , ! w S sa D&-3 25 L � 13�,,J 1 48 170.441 r/ ��— a tL.� r✓L .- 3d ' �0 P ' 50 tk OF 50 ,20° " A SITE AND SEWAGE PLAN i \i EY LOCAT I ON : 4,3 S46HEM Doty 67 1 1 Ho. 1140 �.�L7��ul LL C- IM4-: D ZC 3 Y �FGISTS � S^NITAReP� PREPARED FOR : GA?�eei /16lq411-Ij - SCALE : / r� 10 I a DARREN M. MEYER, R.S. WDATE: P.O. BOX 981 EAST SANDWICH, MA 02537 W DATE HEALTH AGENT Ph: (508) 362-2922 3 W 1