HomeMy WebLinkAbout0157 BRISTOL AVENUE - Health IS7 Bristol Avenue—
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Hyannis
M
TOWN OF BARNSTABLE
LOCATION �S� ���f'lo` �y� SEWAGE#02 c%s'
VII';tAGE ASSESSOR'S MAP&PARCEL-1 9v—
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY. (type),.Co.vGG�aP7e'' (size)
NO.OF BEDROOMS T ;
OWNER
PERMIT DATE: COMPLIANCE DATE: 7-",000
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ; �� Feet
Private Water SupplyVell 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 44-6&�c
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No. 3� Fee Uu
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftphration for 33isposal 6pBtem Construction permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No./3''7 l80Z/f'7''jJJ�� Owner's Name,Address,and Tel.No.
Assessor'sMap/Parcel a� 9/ / 4/o -� v
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
-7J-
Type of Building:
Dwelling No.of Bedrooms 1<__1 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building�edz No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��/4 gpd Design flow provided ` gpd
Plan Date 2" Number of sheets J Revision Date
Title �, p
Size of Septic Tank ��� �� '0 O Q Type of S.A.S.
Description of Soil e-Gz`
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 ealth. `�'V
Si Date
Application Approved by Ae ie r Date �— .2
Application Disapproved by V Date
for the following reasons
Permit No. 9-d (J-- I J 1 Date Issued
hd ..
w--
r `
No.1 0, 3y Fee ( Uo
` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION,- TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9ppIication for Misposal 6psttm Construction permit
Application for a Permit to Construct( ) Repair(fi�Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No./:'17��/.f'�"o��l/ Owner's Name,Address,and Tel.No.
y Assessor's Map/Parcel � 91— /o r
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
(j'JJl7 LC`$G'cFv� 77r OJO �i�vF � �f,JQO� /��
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building4;;ed!r"P No.of Persons Showers( ) Cafeteria( )
Other Fixtures ►�
Design Flow(min.required) ��/O gpd Design flow provided y gpd
Plan Date C.tti l,� -� ( � }J-r". t i
Number of sheets Revision Date
Title
Size of Septic Tank G�X �O:�O Type of S.A.S. G O.vGe-TCT�'
Description of Soil
-7 r/r
Nature of Repairs or Alterations(Answer when applicable) • P e}�
a
.r'
Date last inspected: .
a
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 ealth.
Si a Date
Application Approved by Date �— 1 Y IS
Application Disapproved by ,Date
for the following reasons
Permit No. 7d (-ram . Date Issued
J `
f ---------------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of �lCompfiance ,
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed'(!) -r Repaired( Upgraded( )
Abandoned( )by �/l ��8�y� cJ
at �����/J'Tpli �'y �� has been constructed in accordance
Y'
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer��A" d"�'O�y� Designer
#bedrooms Approved design flow 7 S 1 gpd
The issuance of this permit shall not be construed as a guarantee that the system will ct' d igned.
Date —2-2 T-71 (`r Inspector
' ------------------------------------------------Fee V
-------------------
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS
Misposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) f
System located at "o" 5"' 4k6C�27 -.1'-247,ol- A vE" ,/ I
and as described in the abbve 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.
i
Pfovided:Construction mustbe Completed within three years of the date of this permit.
Date �/a `�// Approved by
r
Town of Barnstable
'"E'0�, Regulatory Services
h�P
Richard V. Scali, Interim Director
a�anar�ece.
ASS. �0 Public Health Division
enaa+° Thomas McKean, Director
200 Main Street,Hyannis, NIA 02601
Office: 508-862-4644 Fac: 508-790-6304
Installer&Designer Certification Form
Date: �� Setivage Permit# 0-"P-r'=-J- Assessor's Map`Parcel Designer: c t , :1 Installer: Jtw`L )F
Address: SX_ 6 .7C0 Address:
On was issued a permit to instal] a
(date) (installer)
�
septic system at �t�_.C� based on a design drawn by
(address)
5 dated
(designer)
1/ I 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. Strip out (if required) was inspected and the soils
were found satisfactory.
I
I certify that the septic system referenced above was installed with major changes (i.e.
Beater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required) was inspected and the soils
were found satisfactory.
I
I certify that the system referenced above was constructed ' -ce with the terms
of the f A approval letters (if applicable)
•;O�,Lt�DAVILi MASON
Instal er' Signa e}
(Design. 's Signature) (Affix DesiOCS.WgfKp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF CO1tiQUANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic`,Designe7Certit7ication Forn Rev 8-14-13.doc
TOWN OF BARNSTABLE
LOCATION /�� �` � � /�� SEWAGE #
.VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. ) 4
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) l� (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER
N DATE PERMIT ISSUED:
DATE .COUPLIANCE ISSUED: G 3 - r6
VARIANCE GRANTED: Yes No
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Town of Barnstable P#
Departitnent of Regulatory Services
Public health Division
Public F ` ate 3b
. I117p 200 Main Street,Hyannis MA 02601
Date Scheduled �/ Z3 Time
Fee14
Soil Suitability Assessment'��
,�or Sewa e D'sp.osal
rn .
Perfored•By:.
Witnessed By: , t
Location Address- LOCATION&GENERAL INFORMATION
Owner's Name
' / / • . • Cr•�li�!/ O �QUA �/I�Q�GI�—•
Assessor's Map/Parcel: 9�// J® Addtasb
Engineer
NEW CONSTRUCTION REPAER
Telephone fl
Land Use-
Slopes(%) Surface Stones .. •
Distanceb room: Open Water Body R _Possible Wet. tt Drinking VllaterWell
Drdlhage Way ft Property Line
—__R Other ft
SICCTCII:(Street name,dimensions of lot,exact locations of test holes&pore tests,toe to wetlands n proximity to holes)
Parent material(geologic)
Depth to Padrock
Depth to Groundwater. Standing Water In Hole:
Weeping 1)'otn Pit Fnce
Estimated Seasonal High Groundwater
Method Used: DETERMINATION FOR SEASONALIH6H WATER TABLE
Depth Observed standing in obs.hole:
Dckh to weeping from side of obs.hole: Depot to soli mottles: !tl
Index Well fr' Reading Date: Index Well level Orottndwater Adjustment gr,
AcU,tttetor _ AtIj,Ot•oundwtiterLevel,, _
` PERCOLATION TEST Observation
Hole 0
Tinto at 9"
Depth of Pere ^
Time at 6"
Start Pro-soak Time
Time(9"-G") .
End Pre-soak
Rate Mih./luch
Site Suitability Assessment: Site Passed 51tp Felled:
Addidannl Testing Needed(Y/N)
Original: Public Health bivlslon Observntlon Hole Data To Be Completed on Back
***Yf percolation test is to be conducted within 100' of Wetland,you must first notify the
Barnstable Conseir vation Division at least one(1)weep:prior to beginning. U
WSEPTIMPERCFORM.DOC V
i
DEEP.OBSERVATION HOLE LOG Hole#
Deptl►from Soil Horizon Sol Texture Shcl Color Soil. Other
Stuface(in.). (USDA) (Munsell) Mottling (Stnucture,Stoney;Boulders.
COT el� etency,96'arayell
0
VT I
DEEP OBSERVATION HOLL LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other.
Surface(in.) (USDA) (Murfsell) Mottling (Structure,Stones,Boulders.
Consistenov.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon' Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%a�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Sall Horizon Soil Texture Soil Color Sall • Other
Surface(In.) (US DA) (Munsell) Mottling (Structure,Stapes;Boulders.
Consistency.
Flood Insurance Rate Map: , /
Above 500 year flood boundary No_ Yes V,____
Within 500 year boundary No I ej '
Within 100 year flood boundary No. Yee .
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pery us aterial exist in all areas observed throughout the
area proposed for the soil absorptibn system?
If not,what is the depth oi haturally occurring per ous material?
Certification
I•certify that on' (date)I have passed the soil evaluator examination approved by the
Department of Envlr mental Protection and that the above analysis was perfor d b me consistent with .
the requ'.ed training,exper' d ri nce escribed in 10 CUR 15.017.
Signature Date 7
QA5 ePTICkPBRCFORM.DOC
ASSESSORS MAP NO:
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Application is hereby made for a Permit to Construct or Repair (x ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
Owner Address
Installer Address
Dwelling X Expansion Attic Garbage Grinder (
ther
Z Other Distribution box ( ) Dosing tank ( )
U Nature of Repairs or Alterations—Answer when applicable..!...QY!qrf.10.W...leach pit. :�r.j
----'--''-----'--------'—'-----'-------'-------------------'---'--------'-----'-
'�,---_-.
� The undersigned agrees to install theuforedescribed Individual Sewage Disposal System in accordance with
the provisions ofgLITilE 5 of theStateSuniraryCode— Theooderxigned further agrees not m place the system in
operation
._.____ 5��� 8�_____..
Application Approved Dv................._�^.' -' ------- - ................Application Disapproved �
Date
for the following reasons:...............................................................................................................
-
.........................................................................................................................................................................................................
Date
Permit No' Date
No ....... �CO FEB.........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
: 0.n........................0F..............�+ .:PI b...CJ
............:....
Appliration for, Disposal Works Tontrurtion lirrmit
Application is hereby made for a Permit to Construct ( )• or Repair ( , ) an Individual Sewage Disposal
System at:
................ .....---•-•.........•................•. .
Location-Address
`' 'r r bs n V t i[1 or Lot No.
{r
....":h.Jt.....�....._r_:......t.:4..... ............................................... .._.._........__ ..............................................
Owner
Address
................................................. ..................................................................................................
Installer Address
Type of Building Size Lot............................Sq. feet
Dwellings-No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures ...........................................
........................
W Design Flow............................................gallons per person per day. Total daily flow..............................................gallons.
WSeptic Tank—Liquid capacity.........._.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 ( . )
aPercolation Test Results Performed by........................................................................... .Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-.___---___--_---.--.--.
IZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 ...................:...............................................................................
O Description of Soil...... .........................
U =------------•---•• --------.-------------•------------------------.---•-----------------------------••-------------------------------------•-----------------•-•-----•---------------------
W
U Nature of Repairs or Alterations—Answer when applicable!.. Y 'z....10 t_ ..G c�C?. 0.1t
-. .................................
----------------•----•---------------------•------------------------------------•-------.........------------...--------------------•----------•--------•-----------------------------•-•--•-------••---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iT-'1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bsen issued by Jhe board of health.
Signed =V--•.......:.....:::........:``�'�� '.±----.....---------- -z�-'1--- ............
Date
Application Approved By...................= .�_. .. :0. . �.-•------••---- ----•----•-••..... ....'`...`�
C---� Date
Application Disapproved for. the.f olloiwing reasons:..................................................................................................................
-•••--•-•-•-•---•-•-•---•----•-•--•-----••--------------------------•-----...-•----•....-•----.......•---.----•-------•-•------•-••--...------------•-----•---•---•---•----------------------•------•-•--
� Date
r � ��Permit No............ --------------•--------------•-------- Issued-----------....----......................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Ga;: ...............................0 F.........P ?"+V.u r .....-'.............................................
Trrfifiratr of Toutphaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by....................................................................................................................................................................................................
[- 9
c3 ;s t jn= ..' c� Installer
at -i �3. i.. :v.l t-� 4 C!is . ! .�`1:.{iL41:..
has been installed'in accordance with the provisions of T ` yi of.•The State Sanitary Code s des ribed in the
application for Disposal Works Construction Permit No...... ._..._._.___�..: 1!.P- dated_... 2gc�. ..._ ......
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A A GUARANTEE THAT YHE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............ ......................................... Inspector....-� -"..... = ...............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. .....�-�C :�: t
No......................... FEE...:..........
Disposal Works Tonstrudivit Vvrrutit
Permission is hereby granted_.. . .... ' '.•-.
-------•------------------------------------------------•-•----•-•-•-----••-•--•.......................
to Construct ( ) or Repair ( ) an Individual Sewage Disposal System
•
Street
as shown on the application for Disposal Works Constructi�Mit_N.a K:7. .-_3- ..- ated.._... -.��
G�
DATE. l ...........................................
Board of Heatth
al
.
FOR 1255 H & WARREN. INC.. PUBLISHERS,
r
ASSESSORS MAP :
TEST HOLE LOGS
PARCEL: '
1) The installation shall comet with 'Title V and Town► of I*rfi ff-,i3oard of
FLOOD ZONE: SOIL EVALUATOR: 1Q IlealthRegulations.
--- -- ---- WI TNESS : 1
2) The installer shall verify the location of utilities, sewer inverts and septic
REFERENCE..
DATE: "�'U ' Z O/ components prior to installation and setting base elevations.
PERCOLATION ATE: --< 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
two leet out of the d-box to the teaching shall be level.
TH- I � v,TH-2 4) This plan is not to be utilized for property line determination nor any other
purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
6) Parkin shall not be constructed over H 10 septic components.
� g p P
7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
LOCATION MAP r 3
(� design flow and number of bedrooms to be considered for design. Receipt
of payment for the plan and installation based on the plan shall be deemed
K/ approval of the design flow by the owner.
To f 9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within the proposed SAS shall
P p p P
be removed along with contaminated soil and replaced with clean sand per A ' j Title V specs.
�� �`' 10)System components to be 10 feet from water line. Sewer !:nes crossing the
V( 1 06 water line shall be sleeved with 4 inch SCSI 40 PVC with ends grouted if
-- applicable. The proposed SAS is being installed below the water service
— -`- line. The line is to be sleeved as aforementioned and maintained in place.
° �- SEPTIC SYSTEM DESIGN 11 If a garbage grinder exists it is to be removed an i the
) g b g d s t � responsibility of the
---- owner to ensure such.
,�� FLOW ESTIMATE MATE 12)The installer is to take caution in excavation around the gas line if such
�j?j
exists.
' ( BEDROOMS AT 110 GAL/DAY/BEDROOM - GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer
lines exitinu the dwelling prior to the installation.
SEPTIC TANK 14)"fliis plan is representative only that a system can fit on a property meeting
I / Title V requirements.
I ( C�AL/DAY x 2 DAYS - GAL
C.J� I � � USE �C GALLON SEPTIC TANK
�to I L AEtSORPT I ON SYSTEM
N __ � 3
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SIDE DE AREA: Z 12-S�v —t— �J� A\(i UAVID
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BOTTOM AREA: X 0�1 � j' MASOi`� rT
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,¢GNU. 1066
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SEPTI T K
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SITE AND SEWAGE PLAN
LOCAT I ON : ICJ �.IL ►�
PREPARED FOR : AIM
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SCALE:-
cc DAV I D B . MASON RS DATE: I lzf1hpl
g DBC ENVIRONMEN AL DESIGNS
W EAST SANDWICH . MA
DATE HEALTH AGENT
( 508 ) $33- 2177