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HomeMy WebLinkAbout0662 SKUNKNET ROAD - Health 662 0 1 Centerville A = 169 • Emmommmum MEN 1■■■■■■■■ ■��■■����■■■���M■NN■■■■■S■■■■MO■■O■■■ 1m■■r■■■■o■■m■■m■m■■■o■m■m■■■■r■vv■■w�■r���MEN MEN MENNEN NEE .000,00000 No NEON MENEM NEE 11 SEE �_Wmm so OEM mmmmm -----------ME on mom ONE ®®®®1i�®oGio® ®®®®®®i�®®®i■®®®®■0■�ii®®®®O®®®®®®OEM®® MENNEN INN 1■■■■■■■■■■mm■■m■m■■m■m■o■■■■■om■mmonso■■■m■■■■ No MOONS INN INN. n No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z LS'XLtiktie X19'T O ner's Name,Address,and Tel.No. /Assessor's Map/Parcel IK / Installer' Name,Ad ress,arA Tel.No. ES -- � Designer's Name,Address,and Tel.No. Z A"? C y oA/A i¢ j /,,car'D �?�'c�•�) ��53; �-►. Cd Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 7 Design Flow(min.required) jC) gpd Design flow provided `�C,(9 gpd Plan Date cz/� //� Number of sheets , Revision Date Title Size of Septic Tank Type of S.A.S. 7 !!2u qwl el Description of Soil Nature of Repairs or Alterations(Answer when applicable) Awe) f —�.- l�s /I'n� ��Sze., 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 iro ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar He th. ` e d1n ° Date 3 l Application Approved by 67 Date Application Disapproved by — Date for the following reasons Permit No. Date Issued /J , V No. r /� FeeTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer:PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Joisposal 6pstent Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No 6 F 51r<G,,t,,x� X4, O er's Name,Address,and Tel.No. Assessor's Map/Parcel f /_ . Installer' Name,Address,and Tel.No. y �� Designer's Name,Address,and Tel.No. An Type of Building: ,.} Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) t ` Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)'7>-3C-> n gpd Design flow provided Z��7 gpd Plan Date 3 h 7 41c Number of sheets / Revision Date Title Size of Septic Tank Type of S.A.S. ,i 19,01 ( 4A 4t!S j Description of Soil f / Nature of Repairs or Alterations(Answer when applicable) �� Ile 1C Ad 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 Ety4 iro .ental Code and not to place the system in operation until a Certificate ofo 'q Compliance has been issued by this Boar v He lth. e , ' ;igneil o i� a ,.. Date 2 Application Approved by / .�� ///�,i,r. %'t %��/�14 Date /� t Application Disapproved by ' i' l Date for the following reasons 1 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(i -) Upgraded Abandoned( )by A f (�rj�"T.f't- to-*I;4,A.> - of ���" ` .�.�f„��i(�'�i�o / ��. has been cons cted in-a c ce 1-a with the proui ions of Title 5 and the for Disposal System Construction Permit No. edI l7 Installer r rr/ Designer. / V i z #bedrooms Approved design fl0P gpd The issuance of this permit shall not be construed as a guarantee that the system w,11 fimc it as e igned. ! "1 Date �,! ,,,._�� (� Inspector ---------------- t---- ------------------------------------------------- -=--------- --------------------- ----- - -- "?No. % � Fee-- '� W THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal 6pstem (Construction permit Permission is hereby granted to Construct( ) Repair(4�-) Up de '") Abandon ,) S stem located at N � 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:ConstT, c on m1771- 4npleted within three years of the date of this permit.Date / � Approved by Town of Barnstable Regulatory Services Richard V. Scali,Interim Director • anaxsrnar.�. MAS& Public Health Division 1639. p'Fo ,�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date:3 aY M Sewage Permit#o?p/6 —� 'f Assessor's Map\Parcel Designer: 7i 4yl*,o g. )411,%W Installer: Address: 4j`T 45'9„oii,iCA/ /'k9 Address: ?j2 /CiDd c��e� RD• On o2! 16 4C was issued a permit to install a (date) (installer) septic system at 4,�Z L<t,6V cVe_t K D• based on a design drawn by address ,c dated / (designer ./ 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 the Y PP g distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co nuance with the terms of e IAA approval letters.(if applicable) i- t\OFA�q�.\? I)AVID y c . (Ins s Signature) MASON Na.1066 7-1 0. . TAS\\P�:� De ' er's Signature) Affix De��:,� i ip 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\Desiper Certification Form Rev 8-14-13.doc f WE Town of Barnstable P# Department of Regulatory Services .BARMA8t.6.: Public Health Division Date �' I L P 6J9.1, - 200 Main Street,Hyannis MA 02601 + toMF� 7 o Date Scheduled ) "� Time y" Fee Pd. d Soil Suitability Assessment for Sew1,eDiswsalPerformed By: Witnessed By: I,,• LOCATION&GENERAL INFORMATION Location Address y�/�i.1y�I Y t Q Owner's Name Address Assessor's Map/Parcel: �j�l�6�T, / ' Engineer's Name t> / V Q i NEW CONSTRUCTION REPAIR Telephone#r JOO `6 Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way It Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ! "1 Parent material(geologic) 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: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ _ '� Time(9"-6") End Pre-soak / �r Rate Min./inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) 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:\SEPTIC\PERCFORM.DOC 1 D e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. . Consistency,%Gravel r o a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency%Gravel) Flood Insurance Rate May: Above 500 year flood boundary No As Within 500 year boundary No Within 100 year flood boundary No_ Yes Depth of Naturally of Naturally Occurring Material Material Does at least four feet of naturally occurring pery final exist in all areas observed throughout the area proposed for the soil absorption system? T40 Q If nojeelij depth f n fly occurring pervi us material? Cert �QI cerQ (date)I have passed the soil evaluator examination approved by the Depnviro ental Protection and that the above analysis was performe by me consistent with theing,ertise�exp 'ence described in 310 CMR 15Sign Date Q:\SEPTIC\PERCFORM.DOC �6 t 7 � L,. �CAT,4ON. ,(�Irrip��r3�- VI .V,1 'SEWA E PERMIT NO. FLAG E A-%��vl't � INSTA LLER'S NAME & ADDRESS jj BUILDER OR OWNER v DA T E PERMIT ISSUED _'Lv DAT E COMPLIANCE ISSUED 2..._2F- - �� vLFxiri !�vr CPJ� Ii J, 0 1'I�rL P�/4 j. LOCATION SEW E PERMIT NO. fi07- 4,/) VILLAGE Y56. 66 INSTA LLER'S NAME i ADDRESS BUILDER OR OWNER ABNfzd R DA T E P E R M I T ISSUED DATE. COMPLIANCE ISSUED y- 2i�-�� (r Ix 33 5 TOWN OF BARNSTABLE LOCATION&Z C1LZw��d�e_T /QD• SEWAGE i/ILLAGE�ei(JI(XV 1LC.- ASSESSOR'S MAP&PARCELI INSTALLER'S NAME&PHONE NO.�OAL(?4 't Doi SEPTIC TANK CAPACITY IeVIO GeZ1,,gA, r LEACHING FACILITY:(type d�C. sizc)p�7 X NO. OF BEDROOMS 'Z OWNER ✓I ttIZAjAJ 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 �� _� 0 � � o - ��,�� . �i �. �: OV-) 1ww - THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ( _ .....OF..... ......................................... 31` pApplirFatiou for BaiipuiiFal Works Tonstrnrtinn ramit Application is hereby made for a Permit to Construct (j/�'or Repair ( ) an Individual Sewage Disposal System at: 7`T......Rit......._`... , �I/%. .RJLfCL' - s? ... ...............• Location-A r s or Lot No. Owner Address a UTo 1.�2 .... oTB.E-(�-a-- sT t3C ------------------------------------------------------- Installer Address d Type of Building Size Lot.a!J9.9.1:......Sq. feet U Dwelling JL No. of Bedrooms_......__. p ( g ( ) a ............................EX Expansion Attic /y®) Garbage Grinder BJp p,, Other—Type of Building __ ............. No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. .. -------------------------------------------------------------------------------------- W Design Flow...........4e.,o.......................gallons per p n per day. Total daily flow.........33.0....................gallons. 04 W Septic Tank—Liquid capacity/00(x.gallons Length 8.P6.e'. Widthf.`.C�_".-.. Diameter................ Depth S`} x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........,C_......... Diameter..../a..r.__._._. Depth below inlet-_ -.v .c ..... Total leaching area../7.0.....sq. ft. Z Other Distribution box (vj Dosing tank ( ) '`' Percolation Test Results Performed by-----I oju,2 .bt...At.-C.Lc;rOAP...h s.-__. Date_._f ,a11 Test Pit No. LAIr-_-_-minutes per inch Depth of Test Pit---Ze_.`........ Depth to ground water.._!:................ (Zq Test Pit No. 2.e- -.._minutes per inch Depth of Test Pit._l�r._...._._. Depth to ground water---&................. a --------•--------------------------•---...-•----.....----------......----------.............--------....................................................._--- O Description of Soil...... .....4.&D......5.v..2150t'�...... `f_`•=- -` _....C!A t_D__... U ....... rllt.......C �P_....� a.`.'. �Z�trd1!? ------------------------••-------•-------- •-----------:a_tAZ4AJ.----._..co1v_ _�T«zit -------.�V... ........ �Sr------.ewc 's----------------------------------•----------------•------. 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 TITL U 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. Si ed ...... .......-...................•-- ��,,�� . ' Application Approved BY � G=L ................... �'�` nab�' Date Application Disapproved for the following reasons___________________________________________________________ ................................ ..--------•----------•-------•--------••-•-------------------------•-----------••-------...-•--------•----------------.....----•-•-•-••-------------------•••--•••-•----------•--------•.............. Permit No......................................................... Issued Z-2,:�' Date . Date No.6):s rJ..b- FE$............:. .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O ...............OF._... /�1�►. T/9 Appliration for Digpos.41 Works Tnnstrurtinn ramit Application is hereby made for a Permit to Construct (1#) or Repair ( ) an Individual""`sewage Disposal System at ........•..---._l......... ....... -----. ......... ---......_ .L.1_... ` �`. Location-Address or Lot No. T ..__^••�-...........—.................................................................... -- ._..._ ......-•-- ---•-•--•-----.._......---....... .----- .-------------------------- ...----------------- _ Owner ,. Address -•-- Installer Address Typ? of Buildi Size Lot_e .'�9.'.' ......Sq. feet awelling YNo. of Bedrooms.___. - _____________________Expansion Attic OVO) Garbage Grinder (NO) a .,Other—Type of Building -- .......... -..No. of persons____________________________ Showers ( ) — Cafeteria ( ) d Other fixtures ............................ �f W Design Flow,.........ll. ........................gallons per per dray. Total daalyrflow.---.-- --------------------gallons. WSeptic Tank-Liquid'capacity Q .:gallons Length__B_.____ Width4'*/_____ Diameter________________ Depth+r`.__�__.__- x Disposal Trench—No. .............____... Width....__............... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_-----/---------- Diameter.__.0!"0.......... Depth below inlet._.XI.G II_____ Total leaching area__/?,.A.....sq. ft. Z Other aDst Distribution box (� Dosin nk ti ( ). '-' t Results Performed b - 4�12It$__ :.0?*A'0 •1,?__. ' Date___AA i_ $ Test Pit No. 1.42.`.....minutes per inch Depth of Test Pit...lF:............. Depth to ground water.../!'____............ GL, Test Pit No. 2._'�''_1'____niinutesper inch Depth of Test Pit_.Or".......... Depth to ground water... !:................ Pi f �r .....................••-r ;r O Description of Soil C3- $ © � � S �'s _ 'R' � �B � A �M et.0.___. vG --- F .r.. .. ......... lGld�9.--_.._ .�1V. .......................................... ---------------- /--f----- GO I-�� /d!1/ ...Vow......... L' d --------------- U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ..••---------••••••••---•••-•••-•-------•-------•---•-•--••----•----••-•••-•---•----•-•••---•••----••----•-•--••-••••--•--••----•••--•--••••••••---••-•••-----•-----•-•-•••--•••••••.._...---••-----•-•- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with 1't,e provision �,.of IITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until il a Certificate of Compliance has been issued by the board of health. Si ned. Application Approved By.... :�. /_/_�}�j / Date ,f. � dC ..�.�..�_/�. +............................... .....Lw�_ 4 (�---------- Date' Application Disapproved for the following reasons------------- -------------------------------_---•------------------------------...__.________________ -•...............•--•-------•---------•-----•------•---------._...-----------;'=-•--------...-------••----•••--•-..._---------•-----•-•••-•-•--------•••••-----------•--••-------••-------•---......... .. Date...... Permit No.............:- ----:-- Issued Date y, THE COMMONWEALTH OF MASSACHUSETTS f,. BOARD OF HEALTH ?own Barnstable .........................................OF..-__...........:.................................................................. Terty iratr of Tomph anrr THI� IS �'O C RTIFY That the Individual Sewage Disposal System constructed (� ) or Repaired t ( ) Vetor no roners: , by............................................................................................------•••-•-----------••----•----...._._........--•------------•----••--....•----...----•-•-------_...•- Installer at.. ..ot .. Route 28," Centerwlllel--Massachusett® s has been installed,in accbrdance with the provisions of T P 5 of The State Sanitary Code as described in the application for sposa .l`Works Construction Permit �o. _ ___________ dated-.--___ /�­_ r y�.r ^'TH.E_ISSU NCE OF THIS CERTIFICATE SHALL NOT-BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM K FUNCTION SATISFACTOft-Y SDATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tom► Barnstable .....................OF.. ::-.-:. f ------------------------------------------------•................ No...-..:S..� .._- FEE._,2,5._9....... is nntrnrtaan rrmit etor norot era Permissiois hereby granted......................................................----..------------------............................................................... to Construct L4toWft 4t6 j8 an d&4M rage Disposal System at No Street as shown on the application for Disposal Works Construction Permit No _....___________ Dated___ _ _,•� ll � y► .. di DATE............................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - - s J 1 4L waxi Noy S-M7 .L/ 1. f/.L >vd IYt?4� H NM4HS Sb' QNn0. 6 3N1 NO `Q3SCktp�ld S/ +1 + d' S1NI-NO NMO119 -9Nla7ln2--.-7/fl ftl rAJ1,1,83:) 00 -H S s��Nn.vv 91 S�S awn O F'f"L.l/-7'0 . 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' ]roar.. . o C) J r • ,� ; n r f n" �.�--' f�,,.�Gb✓-�'�fit}f ' .�������� \.+ � " -�p. fl - y GAS 5 IV �. .,, -_ Wpd" , gle 3Nt'1 N3XOaET 310N' ASSESSORS MAP : _Ig _ _ TEST HOLE LOGS PARCEL: 1) "fhe installation sliall co:ri,:,ly with "Title V il,,J 'i,oNvu of oard of FLOOD ZONE: wc:1 1� ��, � SOIL EVALUATOR : �U1� I lealth Regulations. _. _ __._._.... .� WITNESS : 2XCypC5 +�`� 2) Tlie installer shall verify the location of utilities, sewer inverts and septic REFERENCE: i - ;� ��— w� �� � D DATE: 1� , of _ components prior to installation and setting base elevations. PERCOLATION RATE:: / 3 All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first LAT I A G'/�/ ) 6 Y p P p g l two feet out of the d-box to the ieaching shall be level. 4) This plan is not to be utilized for property,line determination nor any other T - I TH-2 purpose other than the proposed system installation. i2oJt,�, 5) All septic components must meet Title V specifications. d V 6) Parking shall not be constructed over 1-110 septic components. 7) The property is bounded by property corners and property lines. � i 1 gJ 8) The property owner sliall review design considerations to approve of total LOCATION MAP �,00 Z l design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan sliall be deemed �V ; ►� ,� approval of the design flow by the owner. 2U 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per Title V s ecs. J / , W ` ` 1 10)System components to be 10 feet from water line. Sewer !roes crossing the / waterline shall be sleeved with 4 inch SC1140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. SEPTIC SYSTEM DES I G N 11) If a garbage grinder exists it is to be removed and is the responsibility of the o owner to ensure such. ` cY) FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such h 2 exists. BEDROOMS AT 10 GAL/DAY/BEDROOM -6 GAL/DAY 13)Tae installer slialI verify the location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting 1� 1 Title V requirements. 0,�'70 GAL/DAY x 2 DAYS - GAL i USE 1M GALLON SEPTIC TANK UttL4�) / 'L G �� SOIL ABSORPTION SYSTEM ' 4) Fri j4 G 2 CO 7 DAVID SIDE AREA• tZ '- `� B. r �l BOTTOM AREA: , Z,. X 017MASON p No. 10( 'ry SEPTIC SYSTEM SECTION #. . —1 MACraw 0 goo IVA(0 bMZt) Li 12p�'043 y 0 SEPTIC TA t � icy ► SITE AND SEWAGE PLAN LOCATION : -4C002 `C-xu4k; b/ g0 LL PREPARED FOR : ( Dl C 01 0 / SCALE: q. p a DAV I D B . MASON DATE: ! / DBC ENVIRONMENTAL DESIGNS z EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2 177 Z