HomeMy WebLinkAbout0045 BRISTOL AVENUE - Health (2) 45 Bristol Avenue
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TOWN OF BARNSTABLE
LOCATION zje,S I-3G2 rro SEWAGE#�Q6
VILLAGE �}�r�,�✓i�o s ASSESSOR'S MAP&PARCEL 301
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INSTALLERS NAME&PHONE NO.h ee,,-1 ro.vf f
SEPTIC TANK CAPACITY FV i s'T /Oa I9
LEACHING FACILITY:(type) _f �a s-a ���•�rapyo ze) 3 6 X 13 X a
NO.OF BEDROOMS
OWNER
PERMIT DATE: a'7 COMPLIANCE DATE: r5 /
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
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No. / Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
..PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Migpogal �&Pmem construction Permit
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or of No. Owner's Name;Address,and Tel.No.
Assessor's Map/Parcel 30
le, CC
Installer's Name,Address,and Tel.No. Designef's Name,Address and Tel.No.
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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) y 4,"D gpd Design flow provided e7l 7 '�f gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank E ,c s �' d Type of S.A.S. <{ 3 o Sy i.✓ r,`/j•i sf T v,,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 sy em in operation until a Certificate of
Compliance has been issued by this Board of Health.
ign Date 0
Application Approved Date
Application Disapproved by: . Date
for the following reasons
Permit No. / Date Issued
'1 Noi O �6D // Fee ®v
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for �Bigponl 6p9tem Construction Vermit {
Application for Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components+
+. Location Address or Lot No. Owner's Name,Address,and Tel.No.
ys L3� /-
, s�-o / %v E /y1*1.7.V y ,,
Assessor's Map/parcel 3 e� C-04
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
2 e r (�111 n S c -✓
so � 7 > ;73 � 2 � � 7
Type of Building:
Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building . No.of Persons Showers( ) Cafeteria( )
Other Fixtures
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i
Design Flow(min.required) y 41 p gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title ^�+
Size of Septic Tank c t s ? / o o y Type of S.A.S. T Z 45-
Descriptiodobf Soil
i -
Nature of Repairs or Alterations(Answer when applicable)
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 Board of Health.Sig is
r Date C �, /Q/
yd i
d DApplication Approve
ate
Application Disapproved by: Date
for the following reasons
Permit No. r �'�--- Date Issued
- --------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
' (Certificate of (tompliance
iy THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( )
Abandoned( )by A A. /- /
at 15/Z r f r o•/ p t ��y r S has bbbeen
constructed in accordance
,with the provisions of Title 5 and the for Disposal System Construction Permit No. 6"" dated
Installer Designer �-)A v 6
#bedrooms • Approved design flower gpd
The issuance of this
npe it s 111 not be constru d as a guarantee that the system tll cfi0n�as designed.
Date �GJ �/ Inspector v
————/ —--———————————————————————————————
No. c� � "! Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
't.5po!5aY:,*pgtem (Con5tructton Permit
` Permission is hereby granted to Construct ( ) Repair ( --<Upgrade ( ) Abandon ( )
System located at G/ S /3 r2 s v� �= /-�s/ r`-� "'' J
and as described in the above Application for Disposal System Construction Permit.The ap licant recognizes his/her duty
to comply with Title 5 and the following local provisions or special coh't ns.
Provided: Construct i n must be completed within three years of the date of this permit.
Date '7 `�-7 / Approved'by-� �
T
Town of Barnstable' 'tio� Regulatory Services
*. Thomas F.Geiler,Director
tblic Health Division
Thomas McKean,Director
200 fain Street,Hyannis,MA 02601
Office:.508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: � 3D A()
Designer: V 10 c3-A450J i 2-L) Installer: �2e_ ( o .y S 7—
Address: . (�Iqu Eve- Address: R a x l/
On ti �>(date) (installer) was issued a permit to install a
septic �em &1
at b i -NL AVl l 6,1tJ l
P based on a design drawn by
(address)
iD 1 dated
(designer)
1-certify that-the septic system referenced above was installed substantially according to
the deli which may include minor approved
design, y pp ed 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 1.0' lateral relocation of the SAS or any vertical relocation of any component
of the.septic system)but in accordance with State&Local Regulations. Planrrevision or
certified as-built by designer to follow. Y=.
,0 OF tij,4s
DAVID
taller's Signature) �; .,
MASON rn
v .9 No:tbM 4
t; � .
(Designers Signature) (,Vfik e. Igner's.StaznV Here)"
PLEASE RETURN TO BARNSTABI.,E PUBLIC HEALTH .DMS:10N. CERTMCAT-E -
OF C2A I..IANCE WILL NOT BE :ISSUED UNTIL BOTH -THIS FORM AND .AS=
BUILT CARD ARE RECEIVED BY THE.BAI2NSTABLE PUBLIC HEALTH`DIVISIDI�.
TRANK YOU.
Q:Health/Septic/Designer Certification Form
t
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
IV lD ��""� ``�� hereby certify that the engineered
red plan signed by me
dated ( ,concerning the property located at
v� �"1"`�� ✓ meets all of the
following criteria:
• Two soil evaluations excavated for detailed examination(no hand augering) and two
percolation tests shall be conducted.
• 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.
• 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) q2, 1
B) G.W.Elevation +adjustment for high G.W. 2,511
DIFFERENCE BETWEEN A and B
SIGNED : DATE: J'ZC)JD
NOTICE . ..
Based upon the above informatign,.'a repair pehhit will be issued for bedrooms
maximum. No additional bedrooms are authorized in the future:without,engineered septic system
plans.
,�..1� 5 2066)
gASeptic\percexemp.doc
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The plans and specifications for every on-site system shall be prepared as follows-
(1) Every system shall be designed by a Massachusetts Registered Professional Engineer
or a Massachusetts Registered Sanitarian provided that such Sanitarian shall not design a
system designed to discharge more chain 2,000 gallons per day pursuant to 310 CMR 15.203.
Any other agent of the owner may prepare plans for the repair of a system designed to
discharge not more chart than 2,000 gallons per day pursuant to 310 CMR 15.203 provided
they are reviewed by a Massachusetts Registered Sanitarian and approved by the approving
authority,
/
/ (2) Every plan submitted for approval must be dated and bear the stamp and signature of
►VV/ the designer,
(3) Every plan for a new system or plan for the upgrade or expansion of an existing system
which requires a variance to a property line setback distance, must.also reference a plan
which bears the stamp and signature of a Massachusetts. Licensed Land Surveyor in
accordance with M.G.L.c. 112, $ BID.
/�4) Every plan for a System shall be of suitable scale tone inch=40 feet or fewer for plot
plans and one inch = 20 feet or fewer for details of system components) and shall include
depiction of:
(a) the legal boundaries of the facility to be served:
r� (b) the holder and location of any easements appurtenant to or which could impact the .
stem;
(c) the location of the all dwelling(s)or building(s)existing and proposed on the facility..
and identification of those to be served by the system;
'(d) •the'location of existing or proposed impervious areas, including driveways and
parking areas:
(e) location and dimensions of the system(including reserve area);
(f) system design calculations,including design daily sewage flow,septic tank capacity
(required and provided); soil absorption system capacity (required and provided); and
whether system is designed for garbage grinder,
(g) North arrow and existing and proposed contours;
) , location and log of deep observation hole tests including the date of test, existing
grade elevations marked on each test, and the names of the representative of the
✓✓✓✓✓✓ proving authority and still evaluator;
(i) location and results of percolation tests including the Gate of test and the nuncs of
the representative of the approving authority and soil evaluator,
G) name and certification number of the Soil Evaluator of record;
(k) location of every water supply,public and private,
1. within 400 feet of the proposed system location in the case of surface water
supplies and gravel packed public water supply wells,
2, within 250 feet of the proposed system location in the case;of tubular public
/ water supply wells,and
/ 3. within 150 feet of the,proposed system location in the case of private water
►►►/// supply wells;
location of any surface waters of the Commonwealth, rivers, bordering vegetated
wetlands, salt marshes, inland or coastal banks, regulatory floodway, velocity zone,
surface water supplies,tributaries to surface water supplies,certified vernal pools,private
water supplies or suction lines, gravel packed or tubular public water supply wells.
/subsurface drains, leaching catch basins,or dry wells; and the location of any nitrogen
✓/ itive area identified'in 310 CMR 15.215 within which portions of the proposed
m am located.
} location of water lines and other subsurface utilities on the facility;
n) observed and adjusted groundwater elevation in the vicinity of the system;
o a complete profile of the aystem;
(p) a note on the plan listing all variances to the provisions of 310 CMR 15.000 sought
conjunction with the plan;
(q) the location and elevation of one benchmark within 50 to 75 .feet of the facility
which is not shbjcct to dislocation or loss during construction on'the facility;
(r) when dosing is proposed,complete design and specification of the dosing system
proposed including but not limited to dosing chamber.capacity(required and provided),
fy ump curves and specificati Sons,number of.dosing cycles and depth per cycle;
_41 { when a Recirculating and Filter or equivalent alternative technology 1s required or
roposed, a complete plan and specification foF the system,including a hydraulic profile;
t a locus plan.to show the location of the.facility including the nearest existing street;
u the street number and lot number,if any, of the facility; and
v) the materials of construction and the specifications of the system.
--M- W7� TOWN OF BARNSTABLE
LOCATION 365101 AIZ, SEWAGE # /V — y16
VILLAGE .-iA ; S ASSESSOR'S MAP & LOT ) - U
a
INSTALLER'S NAME & PHONE.NO.41,6.
j SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) / u ejAl %A t (size) . &I, X Oayq
NO. OF BEDROOMS PRIVATE WELL OR Eg ATER
BUILDER OR NE / /e
DATE PERMIT ISSUED: 8"
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
41041.1" : :y
33�
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ASSESSORS. MAP: � ��
TEST HOLE LOGS NOTES:
(V PARCEL:
�� IA�QV� S01 L EVALUATOR: D AV 1 MA ��
FLOOD ZONE: L�' �/ _ S S- VV 1) The installation shall comply with Title V and Town of Barnstable Board of
1- V4 9 c
1 , ---_.._- - WITNESS :
R EF ER ENGE ►a _.�_ .-_. ��"1U 3 �. W I 1 DATE: ,fib /� /�� Health Regulations.
`— 2 The installer shall verify the location of utilities, sewer in
PERCOL T ION RAT a:.,G 2 Mt ) fy es, see inverts and septic
-- components prior to installation and setting base elevations.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
TH' I TH'2 two feet out of the dbox to the leaching.
ter} b 4) This plan is not to be utilized for property line determination nor any other
47
purpose other than the proposed system installation.
6 l0 5) All septic components must meet Title V specifications:
.� le
70, 6) Parking shall not be constructed over H10 septic components. Proposed units
are H2O.
LOCAT I ON MAP lr�'r"S, 2� 1• CD !'� �� E.? S 7 The roe is bounded b roe corners and property lines.
'� � ' � � ) property rtY � Y property rtY P P�'h'
G► w� �( /a�� 8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for design: Recei' t of
D, �o h t g g P
g /f �, �y.��J payment for the plan and installation based on the plan shall be deemed
�,Z l (. approval of the design flow by the owner.
2► ! Z 140Y7 1 9) The existing leach pit shall be pumped and filled with material per Title V
' abandonment procedures. Those within the proposed SAS shall be removed
Np up, IPA
along with contaminated soil and replaced with clean washed sand per Title V
g P
�. r specs.
10)System components to be 10 feet from water line. Sewer lines crossing the
SEPT SYSTEM SIGN water line shall be sleeved with 6 inch SCH 40 PVC with ends grouted.
EPTIE
11) If a garbage grinder exists it is to be removed and is the responsibility of the
i�
FLOW
to ensure such.
ESTIMATE
�BEEAOOMS AT GAL/DAY/BED 0OM Aq0 GAL/DAY
fw -IEPTIC J TANK
00
GAL/DAY x 2 DAYS GAL
USE /000GALLON SEPTIC TANK (f'4-101,.-I_L��_-.._
N
4b,
SOIL A111SO-WTON SYSTEM
370
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< V'
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w I DE AREA: Z `T
` \ � _ EOTTOM AREA: 3 , I2-1 5 X O '2 VA
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�-�- EPT i (; SYSTEM SECTION
mot, _
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x.i�T�WrIG ' wK� _ _ . _. _may, 2� b''► w Mix. ,, „
tt wllw, Mwr, q M41
y
/000 GAL p.5 fit T �'40
I ,a � , , C b 4
SEPT1 C TAW
OF
DABVIC1 � SITE AND SEWAGE PLAN
MASON m
ao.tos 6o LOCATION :
�15 2►Snt.., AueW v -
IBTE 1 '
"- PREPARED FOR : MIKC L-VMZ4 60riC
P
SCALE:
W DAV I D B . MASON ?.,5 DATE: o o�
DBC ENVIRONMENYAL DESIGNS
EAST SANDWICH . MA
DATE ' HEALTH AGENT ( 508) 833_ 2177