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HomeMy WebLinkAbout0128 BISHOPS TERRACE - Health 128P'Bishops Terrace Hyannis, A252 "178 h TOWN OF BARNSTABLE LOCATION -%a �7- � �51a SEWAGE#4*W VUTAGE ASSESSOR'S MAP & LOT-1-TO I ) INSTALLER'S NAME&PHONE NO.I?P-,i", SEPTIC TANK CAPACITY X s7 /4'o d _ LEACHING FACILITY: (type AS'-F/2..s' (size c)- NO.OF BEDROOMS 3 BUILDER OR OWNER PERMTTDATE: COMPLIANCE &ATE:, Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 ^` r 1� 8 � � r 1 (� J No._ • Fee l y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Oigpood *pgtem Congtruction 3permit Application for a Permit to Construct( _ )Repair(grade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1028fs�o�s Assessor's Map/Parcel 2s oZ l"! � Installer's Name,AAdddress,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 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow -gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Joao Type of S.A.S. 3� t, w� r,%t 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 CoAq and not to place the system in operatio until a Certifi- cate of Compliance has been issuQd by this BqxdoWalt Si Date 6.S Application Approve Date Application Disapproved for We following reasons Permit No. 0o Date Issued 4 No. 00 13 = Fee THE ..COMMONWEALTH OF MASSACHUSETTS Entered in computer:-e� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppricatiou for 0iopool 6potem Con5tructiou Permit 20c, Application for a Permit to Construct( )Repair( Upgrade( )`Abandon( ) 0 Complete System ❑Individual Components Location Address or Lot No. x4 Owner's Name,Ad ress and Tel.No. �vsSE/� TvL% Assessor's Map/Parcel ., Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. Type of Building: / Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(X Other Type of Building No--of-Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank X I WO L' Type of S.A.S. C: t 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 C de and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health.-- Si ned Date�_). 6 S` _ -Application Approved�b � � � S Date Application Disapproved for the following reasons Permit No, '7 o d l -/ - Date Issued t`/ - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance J. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired(Y )Upgraded( ) Abandoned( )by /P /L G /_ _ _ .at / jf L3 t s o.� / /( n A E" has been construc ed i accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 20 t, 5 '/3 dated ? �.Y _. Installer A IL C /y Designer 610At /1 /L The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector — � I ,� ------------------I-- — ---Fee —No. 2� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �- Migooaf *pgtem!�Upgrade u,5tructiou Permit Permission is hereby granted to Construct(_ )Repair( ( )Abandon( ) System located at / ,2 Bl .s 2 Ae- A 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:Con truct on must be completed within three years of the date of this-pc Date:_����U� Approved by.. V 1l�rv 'v/L 5 1 9/16/03 Notice: This Form Is To Be Used For the Repair.Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, -opt2aEti kt-gN , if -,hereby certify that the engineered plan signed by me dated ,concerning the property located at &,Ct d PS ��"—AtE meets all of the following criteria: • This failed system is connected to a residential dwelling only. There.are.no commercial or business uses associated with the dwelling. • The,soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will-be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). 7 2 B) G.W.Elevation +adjustment for high G.W. __ tj/A DIFFERENCE BETWEEN A and B r SIGNED: DATE: 3 ! off- NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc a. /TOWN OF BARN9TABLE LOCATION 42 et �iS�i � SEWAGE# VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE 5 SEPTIC TANK CAPACITY i J / LEACHING FACILITY: (type p���oa�,.S�t��2S (size Sr.e (-3 a� NO.OF BEDROOMS 3 BUILDER OR OWNER �� rJssc/� %i/o z PERMIIDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 zIr =el/, 9 F5-1 G7 � ' ���3� Town.of Barnstable °EjHF TO L Regulatory Services Thomas F. Geiler,Director + BARNSTRBEE, • Public health Division aTFpa Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: l � Designer: IDA9*01 r"l Y"I Installer: Address: . T 0 �jl i Address: ��Ob x 5 - Ga,,JY)VJIW WOM7 11111,4 f On A-a Y Coil I ' was issued a permit to install a (date) (installer) septic system at l2� 15151'oK7 r yx e based on a design drawn by (address) V✓� l dated (designer) X1-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. 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 Plan r ision or certified as-built by designer to follow. �iH of AfA p•R S�cti 0 0 E tiller's Signature) . 1140 0 STIS �J �gNirAR% (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BA.RNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMBLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Healtb/Septic/Designer Certification Form ` L T'TS THE COMMONWEALTH OF MA t- h. y ��-c BOARD OF HEALTH TaT .....:oF..:.:....... : ;�b�e..:-�.......... ........, "vidual wa e Disp al S,$tem nst ,su �X THIS IS TO CF,RTIFY, That,% Ida ho s er�ace, ' ' a is, b� b� --) rrSR� � > A & B Cesspool Service, is by--- ----•------ .._.. --------•-•---•. P - ichard L Silva -- Ii -'. 'R ----- Done a-- Circle Centerville MA -- at -3 1 has been installed in accordance with the provisions of TI` r•", j of The State Sanitary Code ras d scribed in the - -—application--for-IDisposal 4Verks C os�sx�Cttclion P ermit �To 80 Z.�.. dated. _-1/---9-80------------ ----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS LIED S A GUARANTEE THAT THE — ;- -- - SYSTEM WILL FUNCTION SATISFACTORY. DAT1:------------1�_.9180.......................................----------- Inspector.--- ----- -- ------ -- a. -- -t�/1i1... --- j -j ASSESSORS MAP : 2 NOTES: TEST HOLE:_ LOGS s. PARCEL : �-7 V 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH pw SOIL EVALUATOR : D .(N1 Ity- R.S. �rz tA `}�IS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF rra q � 4 FLOOD ZONE : (SON �P� -ZAc-�- „► WITNESS : ��A1 — tL��vt �—� '' Y ISTI BOARD OF HEALTH REGULATIONS. s�- � ^.� :I.sty 44 YGR� � REFERENCE ' LC p I Z' DATE : = I� _ 2 0 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, ' aR PERCOLATION RAT:; : 4- T2MInJ/INU4 SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO rat �,r INSTALLATION. �•/3�.' ) �,��y�14q �,, C L- �j s a I �T)"S ~.c 0,7 / r TH- I �(_: '�( ' 'p TH-2 / 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION K'rsru R° U -- ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE M DETERMINATION. As ro « � ' A L-UU"A- 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/$ "/ FOOT. (UNLESS >f SD SlkN1P ( IQ SPECIFIED OTHERWISE) L O CA T I ON MAP N, S� 1?2 1 ((a�R5� 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A e. p GARBAGE DISPOSAL. m aD( m p 6) SEPTIC TANKS' AND DISTRIBUTION BOXES (WHEN INSTALLED) f ( Q� MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON� vi.oA BASE OF 6"OF CRUSHED STONE. 7. EX1ST1N USPICN FIT TO C�,iE FVMPE / G12t) I-E0 SEPT I C; SYSTEM DES I GN c��R 10 v ►r�� c p"M _T1Tz. �/ � „� 1 Qr pr ! g��CF 1 0� govN FLOW E"T I MATE of 72 � BEDROOMS AT 110 GAL/DAY/BEDROOM - UGAL/DAY Co 6Q USS ELE °p�Ut� 72 172,00 ft _T oP�pT�oN Pss�° ��'—-0�` i°�_�Pt�T� �I,AcTI��� �?�1►2-t�i� 11�_ ', l z u�a1-1ca �UIf6-0 F04- E�� T 30 . , SEPTIC TANK 98,45 s{ *Y i �y piSH 1 AREA 2 PON i 3�30 GAL/DAY x 2 DAYS - 6(f6 GAL USE 14t 00 GALLON SEPT I C TANK —6- KISTmIAk- - V/�� �700 64L L 5 F-FMovA-L 10 ID 70 S �7-7L -,Vk . I j- F,j-s L_ a�C. Co�(•,� oR- yyt O.:FL'OPOLE GPRPG� SO i L ABSORPTION SYSTEM t©n 0 r- C c� Use._ -Z-) 5Q:) G �- s' Y I DE AREA: U2� 2-. 4-05)-L`�X 7- x © l 1 .` �o l Flo (11J G m � � 1 J ° Na�G E `SLL�N EOTTOM AREA: 2S x 13 K gca,SU m E)OemNk VIA FNok �� 1 tEA{.ft OF SEPTIC SYSTEM SECTION a "b� w- � _ .x !0' (p A{ T'1 k}!`� <� U Yet dde-,�//, f 5Tl (�sfaG� 1� U DEL o Qj 7� wo*(\ vJ eX1STi D B- GAL 6,7 I SEPTIC TANK c I�vlI� n J ig 1 OF 7e5 0 C.0 l � S` S-0 SITE AND SEWAGE PLAN OF Mrs � LOCAT I ON S 6 o`er Al E �GN t PREPARED FOR : 1140 �S�R P� SCALE : r�=30 DARREN M. MEYER, R.S. Z P.O. BOX 981 DATE : l2 23 Z EAST SANDWICH, MA 02537 w DATE HEALTH AGENT Ph: (508) 362-2922 3 w z