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HomeMy WebLinkAbout0306 WHITE OAK TRAIL - Health 306 White Oak Trail Centerville A= 192-252 5 M EA D No.Z-153LOR UPC 135u somiLoom • Mach to USA w•u�Mwnmuaw 01H � e r No. CPO © j ; Fee ®� r Entered in computer: THE COMMONWEALTH OF MASSNCHUSEITS . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,MASSACPHUSETTS Yes �� Application for Z'ioo�al 4vztem Con.5truction Permit /p l�ion r a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System /Individual Components Location Address or Lot No.' Owner's Name,Address,and Tel.No. GlX We' 1�0G6:,4 Assessor's Map/Parcel � oZ S� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building ref- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Q Design Flow(min.required) gpd Design flow provided / gpd Plan Date / Number of sheets f Revision Date Title n n Size of Septic Tank �`XJ, i�� �'o ��- Type of S.A.S. '�(�1,.1�,�1,�1G,(�,Q_J'r/ Description of Soil 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 B of Health. Si Date Application Approved b NDate ,/ J A Application Disapproved by: Date for the following reasons Permit No. Date Issued N. F v ee .THE COMMONWEALTH OF MASSP�_HUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes A�9 Applicatio,n for Xh�pogal *pgtem Construction pantit , _ALJ + Applca i�on for a Permit to Construct( . Repair( ) Upgrade( ) Abandon( ) ❑Complete System L'J Individual Components Location Address or Lot No. x C�wT Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �� r o > Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building GI4r No.of Persons Showers( ) Cafeteria( ) Other Fixtures Q Design Flow(min.required) gpd Design flow provided -3 % gpd Plan Date ;;Po� � �/� Number of sheets 11,11, Revision Date Title Size of Septic Tank -df5" 'T%/Z-1 G /o Co 664c Type of S.A.S. IQ. . Description of Soil 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 Bpaffl of Health. , Signe. Date Application Approved b� Date �CJ/ 1 Application Disapproved by: Date for the following reasons Permit No._S�a!I �I- Date Issued d 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 at -�o� ��y/jE ��.�" JrG�f��L G E�1� has been constructed in accordance with the provisions of Title 55 and the for Disposal System Construction Permit No. yC(P dated Installer L%-,ow �c�o cCl//� Designer #bedrooms .3 Approved design flow 3 J' gpd The issuance of this permit shall not b construed as a guarantee that the sys m will con s :psi . ed. Date �o� �� Inspect - -----j----J_— -----•— -- -_---_--- --_----.— /------- �. No: L/" r-- I Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 1wtgpogal �&pgtem Construction Vermit Permission is hereby granted to Construct ( ) Repair (� Upgrade ( ) Abandon ( ) System located at 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 ust be c9mpleted within three years of the date of t '�s permit. Date l l Approved by Town of Barnstable , Regulatory Services Thomas F. Geiler,Director BARNSTAB16 . public wealth Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: Sewage Permit#�f��-y�� i g Assessor's Map/Parcel Installer&Designer Certification Form Designer: Eli 91 j,u/[1A. � ,Gt �l Installer: � �vf Address- Address: On 2 tX(installer) was was issued a Permit to install date septic system at WRS � � �[y based on a design drawn by (address) MW dated � 30 U 11 I� (designer Cefy that the stem refer septic s the desi •y enced above was installed substantially according to gn, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (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 i • certified as-built by designer to follow. Stripout(if Atefts- acted and the soils were found satisfactory. DAVID �y G (Installer's Sigxxatuxe) MASON !s T (D ner s Signa re q PLEASE RETURN TQ BARNSTASLE PU15 OF CO1VI1'LL,NCE WILL NOT BE ISSUED UN a sL nu 1 tit x xxia r URM AND AS BUILT CARD ARE RECEMED BY THE BARNS 'AB LE PUBLIC "EAAY1Tl~T Dl^VrSTON.THANK YOU. q:bffice focmAdesigiercertitication fonn.doc • Town of Barnstable P# 7 Department of Regulatory Services Public Health Division Date 59 a�� 200 Main Street,Hyannis MA 02601 Date Scheduled // So 2DlI Time/0 p Fee Pd. 1001 O Soil Suitability Assessment for Sewage Disposal Perfortned By _' K kr-> MJgC ok-1 Witnessed By:ZIDA/ geS LOCATION&GENERAL INFORMATION Location Address y/'yam' - - _. _.— j-f�/- - Owner's Name - L l � 0< '�� ` _o Address Assessor's Map/Parcel: f Z 2S Z Engineer's Name' 6-og-Q -z� NEW CONSTRUCTION REPAIR Telephone# V Land Use Slopes(%) Surface Stones Distances from: Open Water Body It Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 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 i i 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 Rate MinAnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation testis to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTIC\PERCFORM.DOC 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) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon - Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistence%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ' Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistences%Gravel) DEEP_OBS_ER_VATION HOLE #LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Mao: Above 500 year flood boundary No Yes Within y Within 500 year boundary No v Yes Within 100 year flood boundary No IXYes_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious aten tal exist in all areas observed throughout the area proposed for the soil absorption system? rf/ If not,what is the depth of n fora occurring pe ous material? Certification Jviro I certify that on0 (date)I have passed the soil evaluator examination approved by the Department of ental Protection and that the above analysis was perfo d by a consistent with the requir ing,expertiseMXpesc ed in.310 CMR 15.017. Signature Date t1 7O 2 Q:\SEPTIC\PERCFORM.DOC TOWN OF BARNSTABLE LOCATION ��� iT�`' O"f"`-t-,vXi4/SEWAGE# V) LAGE ASSESSOR'S MAP&PARCEL S'"--7- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYi>Ti�� ®Qo er'4�• LEACHING FACILITY: (type) (size) NO.OF BEDROOMS .� OWNER G'Z-4 PERMIT DATE: >> — o _ >� 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) —1-111' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A s-_ i8 "d �s�c�sTi•�G /ova 6:.4L, f , 60'1 No.................. �; _ FEB.............................. THE COMMONWEALTH.OF MASSACHUSETTS BOAR® OF HEALTH --------------OF...... ���'.Y e..7.. ��:. 1 ApplirFa#ion for Disposal Works Tonstrurtton jiumit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal syst7 �/7 to &//4a!C_.. ..........�? off' 2� �Y1ofC�� .. ...... ................................. ._......... —"on- e%' y or Lot N l® l�C...��_aah - S/..._.l._. �ef!A ... � ��O� .. ............... .. �/t1.� :_ �• Owner Addres ........�.... ........................•--••------..._...._...• --•._ � ..�... '.__. r .............................. [Installer Address Type of Building Size Lot 0 ���_1/. f._t.Sq. fee Dwelling—No. of Bedrooms............................................Expansion Attic j�® Garbage Grinder s `W Other—Type T e of Building No. of ersons__...__...................... Showers t� YP g ---------------------------- P ( ) — Cafeteria ( ) G" Other fi res --•-------------•---------•-•--• --- . WW Design Flow..................._.................gallons per person„ er day. Total daily flow__._.... .Y�..._..___.._......__._..gallons. W: Septic Tank—Liquid capacity .®p?gallons Length __1_4___-__- Width---16......... Diameter________--___- Depth...16 � x Disposal Trench—No. ............... Width.____.e_ ......... Total Length...........o-_-.....Total leaching area..............A......sq. ft. See1­4page Pit No........_./___-__-- Diameter..... _.__..... Depth below inlet....6............ Total leaching area."I....sq. ft. z Other Distribution box (� ) Dosing tank /� Percolation Test Results Performed by._- .�..j.?. .._��r.. ._!.d _�................... ... ....... .. a; Test Pit No. 1......O.....minutes per inch Depth of Test Pit___6............... Depth to ground water P........ W 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --•-- 0 Description o� Soij----------- --------- --- ----� . ;r4 ;z /. .. V�............................................... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -------•--•-------------------------------•--------•-------•---------------•-----------------..............-•---------------------------------....--------------........-----------------.......-------- Agreement: The undersigned agrees to install the aforedeseribed Individual Sewage Disposal System in accordance with the provisions of TIT E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by e board of health. Sig -• ..... -- ............................. ��' -.F •- Date Application Approved By....... �, Date Application Disapproved for the following reasons:..................................... . ••••------•- .............................•-•-•-•---------------------•--•-------------.._.._.._..--------...----•------••-•-•-•••-•-•-••-•--•------------•-•---......-•••---•--------•-----•-•-----------•---------- Date PermitNo......................................................... Issued....................................................... Date d'/1 G�• FEE..No ...-No...---• -- ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH ..........................................OF......,0ar"i7s '.�i �e ...................................... Appliration for Dhipaaal Works Tonotrurtion Prrutit Application is hereby made for a Permit to Construct k) or Repair ( ) an Individual) Sewage Disposal SystPA/-tom . a K ��l` I L .�_�._07'_ ..7. `- e�q )7 le r v/C_/C ....... • - --- ---------- ocation- res or Lot Noel IV ......................... ....................................................Owner �..... ....................................................Add .............. --...... ..... r.:�.r f.F_.. e.. aa�.�. a i t m.�s } Installer Address Type of Building Size Lot_...___i...................Sq. fee Dwelling—No. of Bedrooms...._._. ...........................Expansion Attic �V Garbage Grinder (gy p Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixiure e .................... --•----- w Design Flow............................ _________gallons per person e�day. Total daily flow...._....._.�_ .____.............. ions. W Septic Tank—Liquid'capacityl�OOgallons Lengthe-s�..... Width............ Diameter................ Depth... x Disposal Trench—No. ._.._._. Width_ ._.T..._.__...__ Total Length.__......._y.___... Total leaching area....................sq. ft. Seepage Pit No----------�........ Diameter.__.. ......... Depth below inlet.__6............. Total leaching area. � ____sq. ft. Z Other Distribution box (� ) Dosing��s A � // . `-' Percolation Test Results Performed by...�/` X__....4".�..............�_e_............... Date...,4�a_. 78. ,,,, jj 0-1 Test Pit No. I..... .....minutes per inch Depth of Test Pit.................... Depth to ground water!_.`.!.°........ �• 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Pd -------- --- Description of,Soil._.________ :/___..__._ .�_ w UNature 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 TITIE 5 of the State Sanitary Code— The undersigned further agrees not to,place the system in operation until a Certificate of Compliance has b en issued by the board of health. ,, r Sign' _. rl1 ;.q?............................ D to Application Approved BY - i L�t11ft f 7= / .-.-- .-----------•--- - • - Date Application Disapproved for the following reasons----------------------•----•---------------------•--•-----•----•-------------•---•------------•--------......•... ....-•--••------------------••-----••--------------------......•---•--••-•-••-----------••-•-.-------•-•-------------•-------------------------------------------.................................... Date PermitNo.......................................................... Issued------•---•---•-----------..............--•--..._...... Date THE COMMONWEALTH OF MASSACHUSETTS ` Ya BOARD OF HEALTH k ............ . ....OF............. ... ......... ....'.............. Tnt tifirFatr of ToutpttFaitrr T I TO CE TIFY, That the Individual Sewage Disposal System constructed ( or Repaired ) by------- •----- ---- — ---------------------- -------------•-----. ---- /�j Y ..... T' In a .. .. . .. at------ . ------.�� �—..-... L�ri'' �r� ���- - 1-- ���............................................. has be installed in accordance with the provisions of TITLE j of The State Sanitary Code as described 'n the application for Disposal Works Construction Permit - �� l�� ........ dated-__- . __ .... ....�.......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A A GUARANTEE THAT THE SYSTEM WI L FUNCTION SATISFACTORY.. .DATE--------. ..` ...... ...................................... Inspector--- -------- --------- •--- ............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1.®�. lo.......... ff)) ......... . FEE........................•►�" t'a�ra ark Tondr ion "unfit Permission i reb ranted...__ Y g :,a ----- -------- to Constr t ( or Repair ( ) a I ividua Seg i osal st at No..- �� `j d� ........ Street as shown on the application for Disposal Works Construction P t N ______ _____ __ Dated.......................................... '?------ -4............................ Board of Health DATE-----------------------------------------------------------------•--•-=---•-•-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS L O CATION A E PERMIT NO. v I L IE --_- /'9 — -- IN5A LLYE 'S NAME i ADDRESS MLEOR III EN DATE PERMIT ISSUED - Ile P DATE COMPLIANCE ISSUED t �( Q�' U����U f !' a4•,. z ��* �C'. �.0 � � � � �� �m � ���e� AsBuilt a Page 1 of 1 LOCATION � � -5-" A # OERMIT NO. 2. 7- ~ PILL I N S T A LLYE 'S NAME i ADDRESS U I L E OR�mn DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED " 7- -- �r pul cam tj http://issgl2/intranet/propdata/prebuilt.aspx?mappar=192252&seq=1 11/30/2011 DV'i 'Zj ASSESSORS MAP : « NOTES: PARCEL : 4Z•Cj _.__ __ _- __ TEST HOLE LOGS 4 SO I L EVALUATOR:- /io�\/I. m k 6%1- 1 The installation shall comply with Title V and Town of Board of FLOOD ZONE WITNESS : --'r' ) p Y - - -- Health Regulations. REFERENCE: n,, 2 The installer shall verify the location of utilities, sewer inverts and septic / 1 !' I�f,�� DATE• 140\/ °� 1 ) fY p _- components prior to installation and setting base elevations. . '� 5�I ! —I-an Z 9� PERCOLATION RATE: 11�1`, 1 ► p p g DID�lb - - 1 - �!�- l (� bo 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first ' `' two feet out of the d-box to the leaching shall be level. TH 1 TH-2 4) This plan is not to be utilized for property line determination nor any other n f AP1� Aqo ,'J F� purpose other than the proposed system installation. 10 i-N1 ' 10 ►�,, 1 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. d► 10 �� �Du,ti°� 7) The property is bounded by property corners and property lines. D { � 8) The property owner shall review design considerations to approve of total LOCATION MAP / n 9l oqo �+c design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed (� ) approval of the design flow by the owner. 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 specs. 10)System components to be 10 feet from water line. Sewer lines crossing the �,�},�,A ` 2jj, water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if ----- - applicable. The proposed SAS is being installed below the water service ' SEPT 1 C S Y:,;T E M DESIGN line. The line is to be sleeved as aforementioned and maintained in place. /y 7, 53 1 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. FLOW ESTIMATE � 12)The installer is to take caution in excavation around the gas line if such exists. �C 0(� 3 BEDROOMS AT 110 GAL/DAY/BEDROOM - 7J'?JO GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer 10 x 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 Title V requirements. GAL/DAY x 2 DAYS • �� GAL USE 1( GALLON SEPTIC TANK1C,1�!�( SOIL ABSORPTION SYSTEM _..._ k2U0 C� *?tLF ' "l - 1 - - --- _ _. ` ` - -- 1 �_ !�- SIDE AREA: 2- X BOTTOM AREA: z X 76 � ca. C SYSTEM SECT I ON ®k quAq L_1 k ds ::a 6r 0 b --- GAL - - - _ SEPTIC TANK ._ � ._ - �f2 -1� DAVIDNOW Bl �pb .o N-6-1, 6 � SITE AND SEWAGE PLAN isT �9 LOCATION : 50(S7 41 T[ 1 1 ) PREPARED FOR : �A150r -TIC M �^ , O t 1/:2 1 � pp JP SCALE: a DAV I D B . MASON 15 DATE: 1� • �� z DBC ENVIRONMENTAL DESIGNS W EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833- 2177 t i ._7 !i(`' . / r r. •Y. 't 'J G 1 L .'/ ri •f. y r /,.r, i� f F. .. Q Q ,►lji 3 ,. � .r! �',l,N" P - -> rrI r ?1 ` ` C VN - — - L71 At- 1 Qj PLAN of LAND r -- CENT,c N v/; k 4 MASS. owN€rj sY ! 1 CERTIFY THAT THIS PLAN SHOWS �ioc , ! THE ACTUAL LOCATION OF THE `��' ' �� STRUCTURE ON THE LAND AND F PANK CONERY 5 TR£NTON ST. THAT IT CONFORMS WITH HYANNIS. MASS. 02Wl �' - BY-LAWS OF THE TOWN "GW*tK" A 'LAND SLOPVVVOR