HomeMy WebLinkAbout0076 BLUEBERRY HILL ROAD - Health 76 BLUEBERRY HILL IZ®AD
Hyannis
A = 249 — 072
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TOWN OF BARNSTABLE
LOCATION #
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY o 6W,
LEACHING FACILITY: (type)i1P2 far ; N
NO.OF BEDROOMS
OWNER e-1 X o,4-
PERMIT DATE: — 19 / 3 COMPLIANCE DATE:
Separation Distance Between the: ✓�7" � �/
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4L 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
tl / - ae
61
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
21pplitation for ;Disposal 6pstem Construction Vermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No.>���U /11e,1 Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel O 1>14
Installer's Name,Address,and.Tel.No. Designer's Name,Address,and Tel.No.
�,7"imp '0 4L"
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(min.required) o gpd Design flow provided 3�O gpd
Plan Date e<��--�'� Number of sheets / Revision Date
Title
Size of Septic Tank��A!',' JS`o 0 GZdl Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) LP ����
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 BoardAHealth.
SignedLZ Date
Application Approved by Date t 9
Application Disapproved by Date
for the following reasons
' Permit No. 9.013 Date Issued
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for Disposal 6pstem Construction i3ermit
Application,for a Permit to Construct( ) ,Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No.
� 1lr��F�(�}� ;�/�� 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.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) $
' Other Type of Building N`f'. No.of Persons -Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ::3� —3' 0 gpd Design flow provided gpd
Plan Date Number of sheets / Revision Date
Title
Size of Septic Tank/Y4::r'6li /S`o 4 G%dl Type of S.A.S. ) ""
E Description of Soil ''4eE
� 1
Nature of Repairs or Alterations(Answer when applicable) lT��`�.ld 1r A' - '
/ C I1
1/ v r
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 of Health.
Signed Date
Application Approved by i S Dated f�
Application Disapproved by t Date
� for the following reasons
i
q >S
Permit No. 0!1 Date Issued r -e12j
--- ---- -----
I THE COMMONWEALTH OF MASSACHUSETTS,
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Ar__ Upgraded( )
Abandoned( )by �/� Lce'���li¢' �('E�®�� �L G.
at ,�'o���� �L //�� /P Q has been constructed in accordance q `�
with the provisions of Title 5 and the for Disposal System Construction Permit No. P a13—2'1 dated +! l {
Installer_�i/� 4�`j&0 e&/C Desi er d�A9 �/�' �f ,
Z �� je�
#bedrooms _ Approved design flow �J 3 gpd 1
{ The issuance of this permit s all liot be coy(struA as a guarantee that the system wi n ion as desig,ed� t'o
Date 6 Inspector rfa , ; r
{ ---No.--- - -- -- ------ - ---- - - ------- ------------- ------ --- ------
Fee
f THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *p6te Construction Vrrmit
Permission is hereby granted to Construct( ) Repair(j Upgrade( ) Abandon( )
System located at >4<
i
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:Con(�truction must be completed within three years of the date of this permit.
Date y (� " (� Approved by
Jun 19 13 09:53p Colleen Mason 508-833-2177 p.1
i
Town Of Barnstable
.. Regulatory ServicesN� o
Thomas R Geiler,Director
sn�v�iilar-.s � mm,
p$ .0 Public Health DMivsion
Thomas McKean,Director
200 Main Street,HyanDis,MA 02601
Office:.%8-862-4644. Fax: 508-7.90-6304
Installer &Designer Certification Form
Date:
Desiper: ti Installer:. L _ 4Mi
L
Address: . Address:" *AWI..
0. was issued a pemit to instail a
(date) (znsiI )
septic system at - based on a design drawn by
dated ' ` 1�✓'
• ' (designer)
1� ��extafy that the.septic system referenced above was installed substautzall}�accord3rzg'to
' �.1ie design,_which may include minor approved' ages such as later ilocatiou of the
dsstribuflon box a adlor septic tank.. -
I certii That the septic systems xeferex�ced above was ins* wth' ji changes. :e.
-- — -
greater tlia3a-10 lateral relocatiari"oftpe SAS or-my vetical` oeafivm o€any tampon
of the.septiasystem}but is accordance with State&i,ocalRegdIations- Plan revision or
certified as b t y designer ti�follow.
(Ins er's Suture} ASON M
Al
(D er s Signattire)
PLEASE RETURN TO �A tI+IS °A I "UBLIC IE EARTH 015MIOM CATE,
OF:C NiPLL4I NCE. 'UAL-:- CiT UED.I II-, . U4
Bin7�CA'RD Ai2E RECENED THE:R TASLE PiMIIC
THAIV�YOU.- <: _
Q:Hea1ti1/Sep�cllJesigner CerhScaAonFaa� • - .. - - - .. - - .. .
JUN. 19. 2013 4. 15PM "'CAP:- COD FIVE MCRTGA 0. 709 '. 2
f
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Megan Dixon
76 Blueberry Hill Road
Hyannis,MA 02601
I
7unc 19,2013
jTo Whom It May Concern;
My parents,John and Muriel Thomas,purchased their home at 76 Blueberry Hill Road in
Hyannis back in 1967. This is,and always has been a 3 bedroom home. I became owner
of this house in 2009 when my mother passed away.
Please see attached sketching of the layout of the house.
Please don't hesitate to call me if you have any questions.
Sincerely,
Megatu Dixon
508.292,7971
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JUN, 19. 7013 4: 15PM CAP= COD FIVE MCRTGA W. 709 ', 3
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No. Oe ` � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ftpYitation for Disposal 6pstrm Construction i3ermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.6 Ct bU1k0 gjT j)k, Owner's Name,Address,and Tel.No.
r"6_Qt1>17N r-A1ZNW0tZ_Tu
Assessor's Map/Parcel 3 7 in s, (0 j"4 Our Opt— H4"Wl
Installer's Name,Address,and Tel.No. 509-0 Tj °7 Designer's Name,Address,and Tel.No.
<dA PC-0 i>c- Cu '�2 tSc� Lk-c—,
153
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(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 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 Board of Health.
Si Date &41 0
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. o 1 a 6 Date Issued
w. .
No Fee J `
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH.DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
application for. Veposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.(o boMo IJT 1)k Owner's Name T A�dress 4and 1.No.
�c�ota�u
i Assessor's Map/Parcel 3 d-7 (M (o 4 'D J Gt t rj LJr t)R �Iy#W1 JI S
Installer's No�mme,Address and el.No. Y7 g�7�7 Designer's Name,Address,and Tel.No.
C04(>C_Wjc?. I -rW Q1!9 LLC.
I-53 Co *C, St M
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(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
i
3Aature of Repairs or Alterations(Answer when applicable)
F
i
Date last inspected:
Agreement:
I i
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 of Healt
Signed Date &-7 o (3
r Application Approved by Date tS 7 3
Application Disapproved by Date
for the following reasons
r
Permit No. Date Issued 1
i ,
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Aband/oned(X)by
at q4 T)U o40 wT-,>R , HY'tNsj IS has been constructed in accordance )
with the provisions of Title 5 and the for Disposal System Construction Permit No-.IL' dated
Installer (�AW GIA.A DC ()-(—Designer J
#bedrooms Approved design flow / ,gpd
The issuance of this permit sh 1 l�be c trued,as a guarantee that the system vvnl�{function s designeil�. j(
Date Inspector �flf l ✓/; g�L tfr°.✓ l i/ „�/V°'�-
r ------------------------------------------------------------------- --------------------------------------------------------------------
i
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
- Misposal *pstem Construction Vermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon
System located at 6 4 I)y( 401L� 1>-P_l UG- ,y kl 1j 15
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 mu t be om fete within three years of the date ofi�this perm'.
r Date ( J Approved�hy
k
Town of Barnstable P# 7`
' Department of Regulatory Services
I3A9Ar6G►14 t B9 , Public Health Division Date KA
i63A a�� 200 Main Street,Hyannis MA 02601
E
Date Scheduled .
Time - Fee Pd.
r
Soil Suitability Assessment for Sew e Disposal
Performed By: ,. •' .Witnessed By:
-5
LOCATION& GENERAL INFORMATION
Location AddressOwner's Name
�y ✓ Address'PA L4'-1e0AVX-
Assessor's Map/Parcel: -2,5:;,' /ri o'C. Engineer's Name.c::�idk�,idLP0J."
NEW CONSTRUCTION REPAIR Telephone# `-o CIA 3 K7
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body l ""eft + 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 1n proximity to holes)
43*�
� Z
'� tV
CD ]a•
1"J a
Parent material(geologic)
Depth to Bedrock PQ
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
CD
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
— - Der..k Obi=+-.a;staritiirrg in 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 qdj,Groundwater Level„•,e
I PERCOLATION TEST bate •h
Observation
Hole# Time at 4"
�r -- -- —
Depth of Pere Time at 6"
Start Pre-soak Time @ •� +t Time 9"•6"
- ( ) -
End Pre-soak
MRate Min./Inch
r
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
+ i a
Original: Public Health Division Observation Hole Data To Be Completed on Back---
***If percolation test is to be conducted within 100' of wetland,you must first notify the.
Barnstable Conseirvation Division at least one(1) week prior to beginning.
Q:ISEPTICVBRCFORM.DOC
DEEROBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, ravel
a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistengy,%
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color' Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, Q v
1._.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders.
+'0Consistency.
a
c
Flood Insurance bate May:
Above 500 year flood boundary No— Yes
Within 500 year boundary No—z Yes/
Within 100 year flood boundary No Yes
Denth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious a rial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of ha rally occurring pervious material?l
tip,•
Certification
I certify that on (D (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection and that the above analyiis was performed by me consistent with .
the required training,expert' e p i ce described in 310 CMR 15.017
Signature
Date
QASBF nCVERCFORM.DOC
ASSESSORS IJAP : TEST
- - NOTES:
i-L S i' HOLE- LOGS
.�' - PARCEL :
FLOOD ZONE: � SO 1 L EVALUATOil : t l��' �� �-'� 1) The iuslallation shall comply with Title V taut Town of/��Boaid o[
REFERENCE:
v----- -- W1 IIJESS : I I lealth Regulations.
DATE: 2) 'I'lie installer shall verily the location of ulililies, sewer inverts and septic,
PERCOLATION IIAI E: 7,) I .r ) components prior to installation and setting base elevations.
l_ 1 - 3) All gravity septic piping to be 4 inch Sch,lO I'VC at 1/8" per lool. 'Ihe lust
,,� - �✓ � two leet out ol'the d-pox to the leaching shall be level.
'111- 1 �, 111-2 4) This plan is not to be utilized for property line determination nor any other
-- ----.._ ____..__ — BUR �sW10 : purpose other than the proposed system inslallrtlion.
N � 443 l 5) All septic components roust meet Title V specifications.
���� lt) t� `( 6) Parking shall Hot be coustntclecl over 1110 septic coutpoitents.
T 'Cite is bounded b property corners and property lines.
Y, b lj�/ �� to 61/ ) property Y 1 l Y 1 1 Y
LOCH 1� I ON NIAI' G � ' 8) 'Clte property owner shall review design considerations to approve of total
41
design flow and number of bedrooms to be considered ('or design. Receipt
of payment for the plan and installation based on the plan shall be deemed
approval of the design llow by the owner.
CI (� �� Ib �� 9) The existing leaching or cesspools shall be pumped and tilled with material
_ �� �✓� per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with cantwuivated soil and replaced with clean sand per
b5 - ; l`,� �..__� Ip,Z a�� Title V specs.
�D gaiv),�4 Ir�p (��yl�, W 10)System components to be 10 leet froth waler line. Sewer lines crossing the
/ water line shall be sleeved with 4 inch SCl 140 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
-- '� S L PT I C S Y S-I E M DES I Gil j line. The line is to be sleeved as aloremenlioned and maintained in place.
l 11) 1f a garbage grinder exists it is to be tetmoved wtd is lyre responsibility of'tile
owner to ensure such.
; LL�V,t FLOW ESTIMATE 12 1 he installer is to take caution inexcavation around the gas line il'such
GAL/DAY � exists.
I_, _
(� m �1 (� r>��'��- f3EU11UQMS AT GAL/DAY/BEDROOM 3)The installer sltalLverrfy the location, (Iuuulily and elevation ol'the sewer
T� -- - lines exiling the dwelling Ibrior to the installation.
SEPTIC TANK 14)This plan is representative only that a system can lit on a property mecting
Title V requirements.
GAL/DAY x 2 DAYS /�bt GAL
USE 1 5- O-D GALLON SEPTIC TA1JK
ABSORPT I UIJ SYS1 EM
Ni _ __ = �- �}� �j'TOI�I Ql� DAVID 9�y
— - SIDE AREA: ��C ?� `� [2v �Z x z), � 1)/9,cS66-6
(3of1OM AREA. 7— X l X O --2v�t�� /sTE
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SEPT I C SYSTEM.' SECT I Oil
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W t 11,16'�
►0 Yti SEPTIC TANK �� ,
`W 7 x lb r
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S I fL- AND SLVIAG- L PLAN
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( 505 ) 833- 2177