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HomeMy WebLinkAbout0041 HEADWATERS ROAD - Health 41 Headwaters Drive Centerville A = 228 — 148 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR FORM" MIN.RECYCLED IQ INITIATIVE CONW10% CeelltedFiberso-ing POST-CONSUMER wWWAlpromram.org S"Im MADE IN USA GET ORGANIZED AT SMEAD.COM TOWN OF BARNSTABLE ar)CATION 1;0"IZ,o*. -46 I�i��E�\r EWAGE# 1;1®,-7—o er,7 VILLAGE ASSESSOR'S MAP.&PARCEL 3'�0Q"�A� INSTALLER'S NAME&PHONE NO. ll;�,00W Zf Wa"a�_ SEPTIC TANK CAPACITY Cow �y�' LEACHING FACILITY:(type) r,r�,l��,t�i (size) /,�XoY NO.OF BEDROOMS 3 OWNER PERMIT DATE: -17 COMPLIANCE DATE: �" as _'000J 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 orr 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 9 5 b` ref H 7 No. ® - � 7 � Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Disposal 6psteiii Caristruttiari Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. /p !� OT Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �Co��7 ��e Zp�-oj / 0 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 4:�e 41CIP No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) :7'�47 gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tankh/� `0' ® � Type of S.A.S. Description of Soil X�Fg- Nature of Repairs or Alterations(Answer when applicable) Date last inspected: j 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 alth. Sign Date Application Approved by Date 6 Application Disapproved by Date for the following reasons - Permit No. � — y tp 77 Date Issued 1p / � 4� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye) PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS P ` 2pplitation for Disposal 6pstpm Construction Vermit Application for a Permit to Construct( ) Repair( ) .Upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. //yG`�� A 41 &T Owner's Name,Address,and Tel.No. Assessor's Map/Parcel e7p Ale ' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. lT rj, ���©�'�i� 9�.s'a,�►o� c��J,���'o.�' off' J'' �'�,� .r'd',.�'7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.-ft. Garbage Grinder( ) Other Type of Building Qi d�f No.of Persons Showers( ) Cafeteria( ) Other Fixtures e� Design Flow(min.required) =�03 47 gpd Design flow provided �,r gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank/l-#*0'W Jf�a O "e, Type of S.A.S. C a o✓ Description of Soil 5V4cr u-G'/.L �O�r 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 Board ogf4llplth. Sign — ^ Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 'ao 0677 Date Issued -----------------------------------------z-------------------------------------------------- ---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS%. BARNSTABLE,MASSACHUSETTS `...� Certificate of Compliance, IN THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed.( ) Repaired( ) Upgraded(� Abandoned( )by 0�rn /' at y/ �/��®�ii/TI�OjJ" /.�lfj has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No%/ Installer L.;G/7j L�Q��, ,�(✓✓�C" Designer�z t�/'p/✓ 40pr f #bedrooms �� Approved design flow 7 gpd The issuance of this permit shal not be construed as a guarantee that the system wil�cti,"a., e * d. _�l Date 1 Inspector ---------------------- - ----------------------------------- --------- ------- No. c:P©I 0 CJ / Fee /Q n THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nsposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade) Abandon( ) System located at --<- / ,f�E„/'�Lv.�f�GC�✓ "e �► G i✓J 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 Pe comp Ld within three years of the date of this pe it. ` Date ��p , � Approved by Town of Barnstable Regulatory Services Thomas F.Geiler,Director '^R" Public Heal. th Division 9 i654 �� �'rForart" Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8b2-4644 Fax: 508-790-6304 Date: / Sewage Permit# � Assessor's Map/Parcel f �. Installer&Designer Certification Form Designer: cDOO11:701 Installer: Address: C:>�tqg-1 Address: � �t `� '�-/� �•�/d-ice/ On .-l -��� was issued a permit to install a (date) (installer) septic s based on a design drawn by (address) .�R��• �"i , 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 distribution box and/or septic tank. Stnpout (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 P- '-tions. Plan revision.or certified as-built by designer to follow. Stripout (if r-- acted and the soils were found satisfactory. OF M9S� DAVID sy�, B. nstaller's Signature) MASDN 9 No.1066 IST / ' l r est er s Signature) PLEASE RETURN TO BARNSTABLE PUB -elf E OF COMPLIANCE WILL NOT BE ISSUED UIV i ij, rsv i ri 1211J k URM AND AS- BUILT CARD ARE RECEIVED BY THE TiRNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. giwftice fonns,tesignerceniticat}on ronn.doc i r' l/�' /��-f� v GuflT�✓?S o L 0 C(�A T ION SEWAGE .PERMIT NO. r 14,14 {VILLAGE T I Z--d eA 32 &v/,A/V/U U A vE 4 S INSTA LLER'S NAME i ADDRESS S U I L D E R OR OWNER / /�R t �✓�S V�D �6 DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED � n uj �o2N 5'A -- - 3/`{' i • 1 �ilia Town of Barnstable P It Departinent of Regulatory Services F Public Health Division Date M j. s'e7➢• 200 Main Street,Hyannis MA 02601 tEil �A ,C0 Date Scheduled Time . Fee Pd. 3, Soil Suitability Assessment for Sew e Disposal Performed•By:- ���� �� ��e✓ 1 Witnessed By: JA/. LOCATION& GE RAL INFORMATION Location Address / � Owner's Name Address Assessor's Map/Parcel: /// Engineer's Name`���i 'fj�i��✓ �`/. A NEW CONSTRUCTION REPAIR Telephbne# Land Use Slopos(96) Surface Stones .. • Distancat from: Open Water Body ft _Possible Wet Area ft Drinking Water Well . ft Dralhag Property Line • o Way —�_ft Other ft SI�L+"TCH-'(Street name,dimensions of lot,exact locations of test holds&Pere tests,lopate wetlands in proximity to holes) Parent material(geologic) Depth to Bedroek Depth to Oroundwater. Standing Water In Hole: Weeping from Pit PACs Estimated Seasonal High Oruundwater DETERMINATION FOR SEASONAL-in' WATER TABLE Method Used: GIX Depth Observed standing In obs.hole: Del$th to weeping from side of obs.hole: In. Daptil to Boll mottled: ill, OrniladwaterAdjustment Index Well Reading Data; Index Well leY01__ �[• Act,titctor Adj.61'0untlwuter Leval,, _ PERCOLATION TEST Bata„ , 'rw,� Observation — Hole a Time at 9" Depth of Pero4Pqsea8jta Time at 6" Start Pro-soak Time @ /Time(9"-611) End Pro-soak Rate Min.finchSite Sultablllty Assessment: Site Failed; Additional Testing Needed(YM) Original: Public Health Division Observtition Hole Data To Be Completed on Back ***If percolation test is to be conducted within 1009 of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPT1C\PERCPORM.DOC 1 1 DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other `- Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stoned;Boulders. rteistcncy. ravel) ' —L7 U r0-, Vo c _ " DEEP OBSERVATION HOLE LOG Hole# Depth from Soli Horizon Soll Texture Soil Color Soil Other- Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Oa DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stoncs,Boulders. Consistency. O DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color moll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistoncy, Flood Insurance Rate Mau: Above 500 year f lood boundary No_ YesZ Whliln 500 year boundary No cq Within 100 year flood boundary No Y65 Depth of Naturally occurring Pervious Material i _Ones at least-four feet of naturally occurring pervl s material exist in all w-eas observed thrpughout the area proposed for the soil absorption system? If not,what is the dep of h turally occurring per ou matorlal? Cer'tificatlon (� I certify that on b ` (date)I have passed the soil evaluator examination approved by the Department of Enviroi imental Protection and that the above analysis was performed by me consistent with the requir ing,ex fibs d e pe iIca described in 110 C]V1R 15.017 Signature Date QAS.EFIrICtPHRCPORM.DOC ASSESSORS MAP : -� -- — TEST HOLE LOGS PARCEL : - I _ V � 1) The installation shall cornp tiVith Title V and Town ofZPH 103oard of �� FLOOD ZONE : V,.. SOIL EVALUATOR :: �� C I lealth Regulations. - - - - - - v-�4 1� - - - - -- -�- WITNESS : ► %J1 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: Z�F'� (� �� DATE: A'(L: components prior to installation and setting base elevations. v PERCOLATION I ATE: Z �- 1►.1, 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per loot. The first sle - - -- -- - — N. 1110 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 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. lti �Z 6) Parking shall not be constructed over Ef 10 septic components. �D -� ZJ 7) The property is bounded by property corners and property lines. 'Q�b ��� 8) The property owner shall review design considerations to approve of total LOCATION MAP iRdesign flow and number of bedrooms to be considered for design. Receipt 1 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 1 tl be removed along with contaminated soil and replaced with clean sand per Title V specs. : f � ``1� � 10)System components to be 10 feet from water Iine. Sewer !roes crossing the � a w , , 1 �--�- - - --- ---- water line shall be sleeved with 4 inch SCf 140 PVC with ends grouted it i., applicable. The proposed SAS is being installed below the water service Pp P p g line. The line is to be sleeved as aforementioned and maintained in place. _ SEPT I C SYSTEM DES I GN 11) if a garbage grinder exists it is to be removed and is the responsibility of the 7/ .31 - owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such � •° exists. BEDROOMS AT GAL/DAY/BEDROOM -� GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer lines exitina the dwelling"rior to the installation. -- ~f L P SEPTIC TANK 14)7 his plan is representative only that a system can fit on a property meeting Title V requirements. GAL/DAY x 2 DAYS - UL GAL USE I GALLON SEPTIC TANK � ���'� o � _��►y�l�.,(,r Sots nTEM ,C�CO�FAI�4S� �� �� � � t a����v DAV1D . � � y o00 \„ I r - o �ilb S i��E AREA. ZX Z 'f l2 'a Z x b y� + MASON `1 \ + BOTTOM AREA: 4� � � m I' _t 11R01 It ��?�',,� toss N �y SI STE _SEPTIC SYSTEM SECTION if — oZ ,3� ID 1`I 3ff C F Z 0t,6L fvuqoz ' 1rOD GAL 0�; COQe. --�t�!'T� yD PG SEPTIC TANK '', � ___ �� DE►�tac.�k:�-tom ........... T� Uzi i t 21 ,00 SITE AND SEWAGE PLAN �.� LOCATION : . G6 IL Ole ° PREPARED FOR : o - ° o O O _�.__- -- SCALE: 10 O W DAV I D B . MASON l DATE: 201� 0 Z DBC ENVIRONMENIfAL DESIGNS U __ EAST SANDWICH . MA 3 DATE HEALTH AGENT ( 508 ) 833- 2 1 77 W Z