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HomeMy WebLinkAbout0352 MAIN STREET (CENT.) - Health 352 Main Street Centerville -•Ai 208_ 152 i i 1 I I i Omrford, NO. 1521/3 ORA 10% i No. 3 Fee i Entered in computer: tom✓ TH COMMONWEALTH OF MASSACHUSETTS p i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplicotion for Dtgool �&pftem Congtruttton Permit Application for a Permit to Construct(14� Repair( ) Upgrade(e Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3'j"�1���i�°'J 7 C406'4'T Owner's Name,Address,and Tel.No. Assessor's Map/Parcel o7 Q P � 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 ��f: No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided " � gpd Plan Date '"�,� Number of sheets f Revision Date Title Size of Septic Tank �r�Q 64J�jClps•. Type of S.A.S. 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 Box4p f Health. Signed414Date 7� 0 Application Approved by Date PIT Application Disapproved by: Date for the following reasons Permit No. Date Issued I No. d �+ T - ,.i; Fee 00� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS N I' 'i pphratton for jDtopo!5a1 �&pgtem Con.otructton Pemtt Application for a Permit to Construct(e Repair( ) Upgrade(e Abandon( ) El-Complete System ❑Individual Components i Div T Cc �T Loc�ion Address or Lot No. .3�e���-�Y� .r Owner's Name,Address;and Tel.No. f lrQ Assessor's Map/Parcel;to P � j Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building 1AP4:F"1f• No.of Persons Showers,( ) Cafeteria( ) ` r r Other Fixtures r I Design Flow(min.required) r'rp gpd Design'flow provided gpd Plan Date —0,7 Number of-sheets !�� Revision Date l Title Size of Septic Tank �'S`o o " P r o s+-+. Type of S.A.S. Description of Soil Z F Nature of Repairs or Alterations(Answer when applicable) i i 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 Bo f Health. 0 7707 r � Signed Date / Application Approved by Date `�� ��/ Q77 i Application Disapproved by: V / Date for the following reasons i Permit No. '01 Date Issued THE COMMONWEALTH OF-MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certtftcate of Compliancoell000 THIS IS TO CERTIFY,that the On-site-Sewage DisposalwSystem-Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by C/ *-I at 3��- t1y�(//✓ (�T' G-Gt`��= has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. (,—7 dated Fl ff x? Installer Designer ��Y/,C� ' /�fi�/'•r �� #bedrooms Approved design flow ` f and I I The issuance of this pe. it shall not be construed as a guarantee that the system wi -f ctio`n as desiJned. n { Date 7 Inspector '(/In+ K -- —_— ------ / _ No. Y ���'�------------------- Fee 1 Z COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS �-�- �hgpo5al 6potem Con5tructton "ermtt Permission is hereby granted to Construct ( ) Repair` ( Upgrade ( ) Abandon System located at S" /�j��i✓ ,j`J' ,�`'it�r. 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: Construct io t be co apleted within three years of the date of this ermit Date Approved by Town of Barnstable Regulatory Services $ Thomas F.Geiger,Director NNW Public Health IjhWon Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: btu 6r 2DO @j ..I Designer: l� j, '�'1�� i Q5 Installer: Address: . Address: ���'� ��r���U was issued a permit to install a ( te) (installer) septic system at �Z �� *W �,� ( based on a design drawn by AN I �( s) - � � � dated (designer) icerki fyy 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. �oT 2)0E V 4 el 4`77a.J6 e J1 �t E70 -77KjE 6p= /h1�72? I•tgi' 7�e $ / , why !cam✓ *111- ` `" o L. the septic system ref renc:ed above was installed with major changes (i.e. T greater 8ma 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance roil&State&Local Regulations. Plan revision or certified as-baik S aS'ignattm) r =; s Signature) - _ (Affix Desi=�. ?-.�. Here) PLEASE RETURN TO BARMT.ABLE PIIBLIC �AL1'�DIYISIQPI. CERTIgICA1'ly OF COMPIdANCE �VII:L NOT BE ISSIIED UNTII, BOTH Mm FORM AND AS- BUILT CAS ARE BY THE BARNSTABLE PUBLIC SEALTH DIVISION MANK Y©U Q:Heap/septicMesigaerCertiEcabon Form Town of Barnstable P# Department of Re $ gulato Services s Public Health Division NAM Date �wrEa 3 °$ 200 Main Street,Hyannis MA 02601 Date Scheduled ✓- Time Fee Pd. la2 . Soil Suitability. Assess. ent for Sewa e D' g Disposal Performed By: • ' Witnessed By: Location Address :51-:, LOCATION& GENERAL INFORMATION Owner's Name Assessor's Map/Parcel: Q S "�5� Address ��� �� .,•�- C Engineer's Named1v.�p NEW CONSTRUCTION EPAIR Telephone# Land Use Slopes(%) Surface Stones Distances from: Open Water Body-� III Possible Wet Area �) �/� ft Drinking Water Well ft Drainage Way-LL ft Property Line ..� --I—Ly_ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n Proximity to holes) *T - c T. ------------------- I i Gc.j Gjj, Parent material(geologic) I 1_1 Depth to Bedrock +1 UY) Depth to Groundwater. Standing Water in Hole: ^ Weeping from Pit Face 1 Estimated Seasonal High Groundwater �V - 4 4� D ON FOR SEASONAL HIGH WATER TABLE Method Used: r Depth Observed standing in obs.hole: in. Depth to Soil mottles: De th to weeping from side of obs.hole: Index Well Reading D e• Index Well level in, Groundwat jAdstmentAdj,factor [ la un dte'rl l PERCOLATION TEST Observation Time " u Hole# Time at 4" C Depth of Perc '� Time at 6 start Pre-soak Time @ � Time(9"-6") End Pre-soak Rate Mln./Irtch 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 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:ISEPTICIPERCFORM.DOC - -• .IYIs�J� a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on istenc % ravel 67 l/ lb 1 to DE P OBSERVATION HOLE LOG Hole# Soil Horizon Soil Texture Soil Color Soil Other Depth from ture Stones Boulders. truc , USDA (Munsell) Mottling (Structure, Surface(in.) (USDA) Consistency.°b Gravel 01 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C n iste c G vel DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil Color Soil Soil Mottling (structure,Stones;Boulders. Surface(in.) (USDA) (Munsell) Consist en F ! Flood Insurance Rate Map: /l ii Above 500 year flood boundary No_ Yes _. f � Within 500 year boundary No Yes `7 C7 Within too year flood boundary No Y Yes_ e Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery material exist in all areas observed throughout the area proposed for the soil absorption system? �--,° If not,what is the depth of naturally occurring per ious material? Certification Hent I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ1 Protection and that the above analysts was peror by me consistent with the required training,eVe 'se d e p i e described in 10 CMR 15.017 U � Date Signature ature Q;WEpTl0pFRCFORM.DOC TOWN OF BARNSTABLE LOCATION � � j�/ham " SEWAGE#:F9:VV1-V— -?4r:7 VILLAGE �, ASSESSOR'S MAP&PARCEL ® � INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 9% Ode wY LEACHING FACILITY:(type) size NO.OF BEDROOMS OWNER PERMIT DATE: 0 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 16 V 3 3 � � , If �yD L F a p0 a v E------------ 11 V P II � O o II Z — I I II ue i1 4 1 I I v }`------ --- ----- - -----J n I 11 I I€I v g: � ir+' � t o a T na O 3 � 1 p I I O C i I _ t I i __----- ------------------------------ '1 NEW NE14 N- TWW2 TWW2 2-TW2442 4'-P 9T- �m �D s I 1 I I 1 a 1 I o I i i I i I I I 1 1 i I I n II 11 11 II II u � D r D n E E � �V o� It n � Is. r Pp � 1. D h SCALE: 1 4�=1-0� atom %a Mom m m COPYRIGHT DATE REVISIONS ,IUS PLAN INVAl1D FLOOR PLANS �- NORTHSIDE UNLESS ACCOMPANIED po IumawS M tin av NORTHSmE HEREBY EIWRESLY DES94 0 1 2 4 B BY A COMPLETE SET OF a`=Isaul.w a DESIGN RESEx�Es ITs COMMON LAW CONSMCTlON DOCUMENTS. A Iola a NOT TO B.7NFSES PLANS ARE t0.D18FA OF ORAWNM M SET, ADDITION RENOVATION Ml�ORa°. "° ASSOCIATES a�OR COPIED IN ANY DRAWN JH SHEET NO. DATE: Ewa a xlal6anAL 0010EM 78 N for BUTERA RESIDENCE ' DE" Ip°n�®a AMM FORM OR MANNER YMAi50FlER MAT BOW aoMDloa oaaoalalla6 TATHDUT FM OBTAINING THE A 05 M t BE u M ran Lu DISONCINE RTSIDENOAL h COMMD2c AL OE9d1 EWRESS MTTEN PFRMmgcN CHECKED 352 MAIN STREET awasm otsNnsar no m Nsrtelm IN MMH sIRE4T•rARMouna'9RT•w oasis AND CONSENT OF NORM9DE r-ENTERVILLE, MA. v�oma 'eosaw aws 1�°��-2210 <sflw'°a-°sax DE9oI ypbytimTIjrnK •T 3 ;Zp vm' D 9 I I m ° 4 A A ^gg� ,m I I I � � � IIIIIIII II I I III IIII = ' D •m I �� j u III m _ ° g r rn m >d .00 I O I — � Z $& _ I �� n Vic I I L Z rig $$4 I o I I - m n� ® I n its "3 p I w I I n I II < �� @ 1 A n3 4^pIp (� F D IIII II I I �r m D < I °, • < m ul 4 � F gad I I I Imllil" I I I � I i I I o m Q mp ° m ul zF I p r s ° `y 7° Tn m V' q O m D N I I I I I I > Z • I T I - = z z 4W 13 ! IS 70 PI O I o = F r • `� GN m ° 4 I i ^ a< m mI=III I �£ D a a by 3 D F vmy SCALE: 1 4•-1'-0' sure.la eu CIX aWAnr nE oawmr. ma ro COPYRIGHT DATE REVISIONS THIS PLAN INVALID rvn Ago�m•ImTI�- NORTHSIDE UNLESS ACCOMPANIED BUILDING SECTIONS 4 DETAIL , a E��COMMON Y DESIGN ° ' z B BY A COMPLETE SET OF s m ax � Igm®E DE9D1 DESIGN CONSIRIICDON DOCUMENTS AssllEs ND REWOMMM m uraRr COPYRIGHT.THE56 PLANS ARE I LIM DP DRANDNGS IN SET: ADDITIONRENOVATIOND" D ° CHANGED NOT RE `90 MY DRAW ,IH MEET NO. DATE: 9 a - ASSOCIATES FORM OR MAN14R WINATSOEYER for BUTERA RESIDENCE "`°�°`"°""®f0m°'"°® YIITHOUT FIRST OBTAINING THE TUT�cmm.D o mNswA:11D•, A. r75 i1j wue ff TN511 ro asnNcnvE RE9DENRAL OONNERtlAL DESIGN DFRESS•KITTEN PERMISSION CHECKED 352 MAIN STREET aeneo Df9ARTFMf A D b�Emm 1.t w sntm•.AMAGUTWOM•w o2ers AND CONSENT OF NORTHSIOE CENTERVILLE, MA. �aN a°'°'-"'D cDD� gyp'• SF p 6 2007 J 1.- -- ~� 1 �&H mv4" v foun� covers R.' -4 cast i ron or �a e r o� Sc h. -4 o PVC- pip y�Z e w�min. rain. "-77tRni Yr ii •I�.-_y,,►aX /,1 (,�_.=.1rC(+ ►,u `l._YU '1 L"a sheof , VT, PiQch V4 Per _ f of ch. yo pv� pipe •' min. p,tch �/g"per ff. �. t= j -flow line � c/ea.n Sa.nol inv. e% •fo',•C hL!$h�d�. J {+1 Ie � p pe°� •' M „ J pt, AIR •°. � e • a/. rre baseV. e„ . m , ° \ 1 !S�e�fic fa�nlC U► r o �oe a; e ;,°,"� „ ; wee • -e" .; ; • o'• ,♦o %o %r7V. a ((ry e • 0 3/4 — //Z WGLShec�• 57�0/7e e ♦ �' • I ..,../ ,ry` � .• -/ ��'� e a° o�o ♦ p e - a o e • e' ° e ♦ e ♦♦ ♦ o p p • r e 1 •(o':,Gt�US1?eO�,e57fOr7 'Lsbase•°• • • disf 9rour?d wader fa•6/e elev. _ 092VJ & -7Z 1f 7•esf 1ioler elev P/2oF/l-E r7ot f'o ScOle _� ..�.� _ _.._ _., ,.._... �U�V Q MUMB E i2 O F B E U/2 O O M S ? S T- �^� GFi,2BRGE DISPOSRL UN/T,: TEST G�A7'E : 7' o T� L E S�r/NI R 7'E D FLOW eA _ GgL./6F�'.�DAY x `^ Bit. t�j P U L 'L/ i�'R T E M/N• /NC H ,-\ yr G R L.l c),g r- /��'�DPr7ED : �' �}V/Q �3, 1\112 6 4 GOB I r I ILUr�1 / f 7 � _ �C E Q S l T R N/� C RPl� E E � EPT C cl - UH G. 7 f G T f�% S C T /� :; . • _ ,:� S E P AN � H I l t AA I ` ^ . �.ER H/lVG ,�?�A �E'_EC�?U//2E /'IEAJT. �t� � r1 J I I 4g._ "v ) _ - '� �-"+''"' GR Iw J I v` 11f S q �./ S/D E• GU A L L L (b t�-.�, . M + B O T TO Nf L3 -7 /� £. TOTAL L E R C H/NG C Pf� C l T x l ► ,. Z i ►jED 5Awr r�! 1eE SEP__VE L E ACHIAl/G CPPtI CITY W� �t . .' t. �/ , lei V4•..� . GAL. ► `� G( Sm� _ • 10 v` f� ALL W0R/<MgNSHIP AND MATE ,2IRLS 108t S1RUI9 J `2, - SHPLL CO/VFOiEM TO .E.P. TITLE S 1.t `A4 �hj AND THE- 7'oWN OF _ ����JT�S�• 6t�6 � 12cULES RND i2EGULgTIONS � S BSU,E'_FRCE O/SPOSf�L OF I SRN/ TR,2Y S E W q G E. 1'L� '111 I S1' I ) Mp /ANGE WITI-H N/N S U/LD/NG * f - E D TE MINED BY BGU Lf�T/ON S H,9 B E• ,2 /NSPE C-To,2 f CoMNI/SS I0AIE,2: 3) 'EXISTI/VG I9 /l/D FINAL G,CF-IDES SHAD -- / ;2EMAlfV ESSENTIALLY THE SfgME. f --- . '�> UHF /h/ST1��-�- E� U R T E• A PP ie v V E D : -- - TT-fE ,G-O�}'�70�..J b�' �I� UTiU �• /A•✓V`5 �' LSD. F ,y ,9 L T N S L P /9 /V OF F'I� O r�' CJ S f� C OAJ STD UC7/O/�/ e `�� ----„b'•- "^ .`.:'x.3 *`w, -y.bS:-W�.a --...y. zt:.Y_�T. � S / T� F=' L. AN � EFE ,eEtic � � i Z� d �/. �. //s ,D r,� 77,97 #2R l /� , � � PAR' E P,19 � E D F O ie .S �S�-/DGI�� U h-1'E Z C� 20 a a D C �. SCAC-. E• . 11 � t�RTE 3 gyp• ex•istir, spot elev, = U•o T\/r W exiStin9 `ohfour David B. MaSon� RS 4VP• prop. fin• Spof e/ev.- = 0. 0 g Prop, pir�. contour = o o-- Title V Septic Designs g �esf /7o/e /ocafion _ , W L O C FAT/O/V MAP East Sandwich., MA 548-833-2177 ZX