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HomeMy WebLinkAbout0029 ATWOOD ROAD - Health 29 Atwood Road [k1 Hyannis �t - n j t i 1 n { I A 1 0 D d TOWN OF BARNSTABLE LOCATION _ r rW60 / SEWAGE # VILLAGE y '��1s ASSESSOR'S MAP & LOT �� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type)T/�G�iJ (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: —"�� ��� 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 faci�' Y) Feet Furnished by U, o � n 0p �Ir t No. md� c�✓� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplicatiou for 10topool *peum Con5trurttou 3permtt Application for a Permit to Construct( . )Repair( )Upgrade( 11'�Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 4;1 l e ,/ 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. -7i 10,4//0 ep Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Cdtf. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow1�0 gallons per day. Calculated daily flow 33 gallons. Plan Date �'`— Number of sheets / Revision Date Title Size of Septic TankX��'7`��"� �o �'• 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 Certifi- cate of Compliance has be ' �Poof ealth. Signer Date ",9 Application Approved by Date D Application Disapproved for the following reasons Permit No. awq 51 z4Date Issued 77) a e4 51 y `' Fee No. " computer: _THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Entered in comp 2pplication for 30iopozal *pgtem Construction Permit Application for a Permit t onstiu Upgrade(k')Abandon( ) ❑Complete System El Individual Components a�J .s.. Location Address or Lot No.lav /'<> �GY.t'/�/Pd �l(/ Ownec's Name,lAd&es�and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �7 r oJo7 10�'yio B /1 {�o yv �P, f' _, 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 y� gallons per day. Calculated daily flow '�`3 gallons. Plan Date �` '— Number of sheets Revision Date Title Size of Septic Tank � .� �o�" Type of S.A.S. Description of Soil Nature of Repairs orAlterations(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 Certifi- cate of Compliance has bee 'ss"me l�b s o go ealth. �y��-,��, Signe - Date Application Approved by Date -'"Application Disapproved for the following reasons Permit No. cc `� Date Issued 1 �C) THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFFY; that On-site e Disposal System Constructed ( )Repaired ( )Upgraded( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.avd v =sv L dated 9 7�v1 Installer �� y ---Designer The issuance of this pe t slhall note be con QSyst strued as a guarantee that thw un tion as designed. Date T � 6 Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ' 0i!5poga[ *pgtem �Con�tru i on Permit Permission is herebyranted to C nstruct( )Repair( Upgrade( Abandon( ) System located at lily �-�a �0, 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 conr rn dtions. Provided: Const ctionimust b completed within three years of the date of this pe it. _ Date: Approved b t TO OF BARNSTABLE L �ATION 2 6ot� SEWAGE #44%111 . f VILLAGE / _r ASSESSOR'S MAP & LOT.J Pft INSTALLER'S NAME'&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 1��G`G,.� (size) NO.OF BEDROOMS —3 BUILDER OR OWNER OMPLIANC PERMITDATE: © CE 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 fac Y) Feet il' Furnished by c 6C o� Nz)Use o so p�- ok ( 0 r Town-of Barnstable Regulatory Services P $ Thomas F.Geiler,Director L pubric Health lffiv ien ems` einas McKean,Director 'I 200 main Street,Hyannis,MA 02601 Fax: 508-790-6304 Office: 508-862-4644 Installer&Designer Certification Form Date: I 00 lWIT) AM .( 1 N�, Installer: Designer: 'T✓ Address: ���! Address: " _�J_�y C (��� was issued a permit to:install a 0. (installer) septic system at �� based on-a-desig�n dr-awn-by _ ( ) dated y . — (designer) according to I certify that the septic system ap ved alcbanges s lg�relocation atio of the the design,wluc�t may mcl Pre distribution,box and/or septic tank. system referenced above was installed with major changes en I certify that the septicsyst onent greater than 10' lateral relocation of the SAS or any venial relocatioon Ply won or of the septic system)but in accordance with State dt Local Regaiati certified as-built by designer to follow. C � f� 4r / (jpstaller'S y (A# ix errs Stamp Here) (Designer s Si ) _ PLEASE RETURN TO BAItNST BE 1 BLE pSSUED UI�PI'l� BOTALM H THIS �1�ORM A� �' OF COLTliNCE WII�L NO BLIII,T CA1tD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEAZ.TH DIVISION. THANK YOU. Form Q:Health/Septic/Designer Certification TOWN'OF BA �A-Bt-R 26 K AtLOC n Na �'• cx�C �`cQ SEWAGE # 02"3y VILLAGE c ,� r�.rt ASSESSOR'S MAP Cr LOT INSTALLER'S NAME 6i PHONE NO. -17 S 1-7UU SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) d T--fQN--irc (size) P''Jx s NO. OF BEDROOMS .3 PRIVATE WELL OR PUBLIC WATER'13,614Z BUILDER OR WNER {`e t DATE PERMIT ISSUED: 0`S DATE COMPLIANCE ISSUED: `7 -)2 "2'- VARIANCE GRANTED: Yes No p_ I r , i No..-...... - Fim.... ..... J,.Z....� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFa#iou for BhiposFal Mods Tomitrurfiurt Errant Application is hereby made for a Permit to Construct ( ) or Repair ( —' 'an Individual Sewage Disposal System at: .. ..4..�}f u. ...._ - .K.:�...--•"---'-----------' ....................................................----.......................................... ,,, �Lgcaanon-A�dress - --. --_. --_--or.Lot No. 1 .Q......................................... ............... G wr. -•----•---....^_•_------...---------...-----• �.. Owner Address Insta er Address d Type of Building Size Lot............................Sq. feet U g— ..............Expansion Attic ( ) Garbage Grinder ( )Dwelling No. of Bedrooms..................�______... W`4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•------------------------------•------••--------------------.................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.10!?9 .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed by----------------- ........................................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ GT4 Test Pit No. 2................minutes per inch Depth of.Test Pit....----........._.. Depth to ground water...................----. W ............ ..................................................... 0 Description of Soil-----------i .S �.._.. .....1-as?. . "� V)`S.-? �`� .--.5,_,.5....c3j--------------------------- W U •--•••--••----•-•-------••--------•••-------••-•---••-••-•-----.....•-••-••--•-------------•-•--•--•----------------•---•-•-----------•-•-••----•-----................................................. W VNature 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha been issued by the board of health. Signed .... .. ..... . . ---- .`�....��...... .............................. --------- Application Approved BY --- ------- ---- --------- ------------------ - Application Disapproved for the following reaso f• ------------------------------------- ------_ ---- ---------.....------. ---............................................ ............................................. .....- ---..... I ....Permit No. .- ------ ----- ------------- Issued .....------ - ........ �O No._ --. ...... Fss_... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF KEAL Hw TOWN OF BARNSTABLE Apphration for Disposal Works Toustrnr#iun "perm' it Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: -•---------------------- ......................_......................................................_----........... nn .Location-A�dress or Lot No. -•................................._.._ ..............S ...................................................................... Owner w dress,,,, Address I n a - '___._- yL!-.✓�.CzS'�._._'�:_'.'K_:�'-- - ----•-.--_, I a.::..._.'.'. Installer Address Type of Building Size Lot---------------------------- q. feet .-r Dwelling—No. of Bedrooms___-------••---•-�-••-•__•---------------Expansion Attic ( ) Garbage Grinder ( ) NOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 0 Other fixtures ------------------------------------------------------.--•-•--•-----••------•••--••-•--------•-------•------•--------..._.....---...._..........•----- W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity_Atf� gallons Length---------------- Width..............; Diameter................ Depth................ x Disposal Trench—No.-------------------- Width-------------------- Total Length______-•----=•_(_ Total leaching area...................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet------ ._..;..... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .11 Percolation Test Results Performed bY--------------------------`---4 ........................................ Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 19t, Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ------------------------------------------------------------------------------------------ �......._... O Description of Soil...=tt----� ` `, �T f 3�•.x __.._ U ----------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------•-- W 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 TITLE 5 of the State Environmental 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. Signedf n!�------------------------ fu�S2- ` re y� Application Approved BYi.A l -- - ° �l f1 1�1 �-1 �- / � o v ....-..----. _ _ ._ o-- ------------f... fe./...._..--.. Application Disapproved for the following reasons--------------------------------------- -- ---------------------------------------------------------.......................... --------------------------- ----------- ------------- ----------- --- .........................................................- - ------ --- ---------------------------------=- . fePermit No. - -------- Issued re/ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifirak of (fompliance \ / THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( X) by ----- ---------------------------------------- ----------------------------------------------------------------------------------------------------------------- -------------------------------------- Installer at .......................................... has been installed in accordance with the provisions of TITLE ,of he $ta I n It nmental Code as described in the application for Disposal Works Construction Permit No. .-�.... � .� dated ................................................ --------------- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE ONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. "'��•, ---------- DATE---------------------1 - Inspectors.............J } THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Z%,` TOWN OF BARNSTABLE No.. ...__. Fes. ...... . 1 � Disposal n ,ks (gran r iu err x Permission is hereby grantedc_.__ .__.__•. _'--=-�_�--------.1- __l._�� N_!\1---- ! d ........................•.......__ I - 3 r to Construct ) A,! �' ( ) an Ind, I Sewn a Dispo• �y'stem �'� ep�r at No...__..-Imo....-!_v_.....' �....._1� a I �� Y r� � Street 7 as shown on the application .or Disposal Works Construction -ermit No.__r �._ �D'a'"t�d7_�1-.........................n..... � DATE. Board of Health .1 FORM 36508 HOBBS 6 WARREN.ING.PUBLISHERS �� .� � �� i"!r �� �y��' .�i.°�ate- �� 7�G -�Iy'S� � ; ASSESSORS MAP: �'2i�' TEST HOLL - LOGS . k rr rO Awe, t- � �t • _ _.._ � a. PARCEL: _ �jPU1Q z 4 , _ ------�9 ^� FLOOD ZONE: SOIL EVALUATOR. V . NOTES: W I TNESS 01 p REFERENCE: + D d _ /// ��;' / DATE �_- Z PERCOLATION RATE: .� 1) The installation shall comply with Title V and Town of Barnstable Board of l -_^-- - --- -- __ Health Regulations. AAA TH- ! ' N_2�-- 2) The installer shall verify the location of utilities,sewer inverts and septic -----� components prior to installation. 16l 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. 4) This plan is not to be utilized for property line determination nor any other i purpose other than the proposed system installation. _ D) /9p 5) All septic components must meet Title V specifications. 7%' i _ LOCAT I ON MAP � �s� i 6) T'h Parking shall�not be bounded over o 10 septic as depicted 7 property y property property P ) P Pe I ti 8) The property owner shall review design considerations to approve of total number of bedrooms to be considered for design. Receipt of payment for the lC1 too plan and installation based on the plan shall be deemed approval of the number of bedrooms. i1 1 9) The existing cesspools shall be pumped and backfilled per Title V Abandonment Procedures. 10)Proposed leaching is to be within 36 inches of grade or provide venting or cut Y � ` grade as permitted by the Board of Health. j 11)System components to be 10 feet from water line. �. SEPT T I L tY S j E M D E Sj N 12)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal., then replace with 1500GST. — A FLOW E3TlMATE BEDROOMS AT GAL/DAY/BEDROOM - GAL/DAY 'SEPTIC TANK 1101, /DAY x 2 DAYS - GAL 'USE . GALLON SEPT I C TANK Q-1t5D�44) _ H 3 ,c 41 J c l DE AREA: Z `'� -�- t MA E OTTOM AREA: Z-1 'A --i SEPTIC, SYSTEM SECTION W , b ,^ j 4C6 aftFuc -� y. (kj' SEPTIC TANK . LY ': Z 2-9 _ f SITE AND SEWAGE PLAN _ LOCATIONS D PREPARED FOR : o o SCALE: DAV I D B . MASON,Re2 DATE: z DBC ENVIRONMENTAL DESIGNS J EAST SANDWICH . MA DATE HEALTH AGENT SOS ) $33-2 1 77