HomeMy WebLinkAbout0184 BRISTOL AVENUE - Health 184 Bristol Avenue
Hyannis
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TOWN OF BARNSTABLE �
LOCATION I8y IS. a06 SEWAGE#a0/�r-4e-5'41
VILLAGE &.4,A ;,3 ASSESSOR'S MAP&PARCELA 9 I -tqq
INSTALLER'S NAME&PHONE NOC.4*Q AIAG (Sl9T•
SEPTIC TANK CAPACITY / 3�a qt/ION
LEACHING FACILITY.(type) :1213 C414dV WS (size) pZ 4'X/,
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: COMPLIANCE DATE: I N 1 b
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) A Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY /! / � '�
d8� �?
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3
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�00
No. ( � S Y Fee
THE COMMONWEALTH OF MASSACHUSETTS r
Entered in computer: V a i pl W10
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes t�pq
RppYitation for Misposal fps etn cor�stru " tt Vermit r A
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) Complete System ❑Individual Components V 4
Location r ,go Npv �H`� Ow9er�s'N(ame ddres ,and Te o S n,
Assessor s Map/Parcel
�� ��I
Installer's Name,Address,and Ifel.No. Designer's Name,Address,and Tel.No. .
Type of Building: 2
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
f Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.require ) gpd Design flow provided_ 3 gpd
Plan Date Number of sheets Revision Date
Title 6
Size of Septic Tank Type of,S.A.S.
f Description of Soil
Nature of Repairs or Alterations(Answer when applicable
LA3,7-H l UCp
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 4Health.
Si Date 11
Application Approved by ZDate
Application Disapproved by Date
for the following reasons
Permit No. t — Date Issued
1 S
t/
., � -No. Fee
U ( 1/
THE COMMONWEALTH'OF MASSACHUSETTS Entered in computer:
PUBLId HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
. 1
Application for Misposal bps em Cor�stru 'on ,Vermit
Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon'( ) Complete System ❑Individual Components
Loc`tion d rgssor Lot o. 1^ I Ow er s a e ddre and Te No
AssesRA
sor sMap/Parcel ��j r
Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.No. Lh-�-I /q}
,.� Type of Building: 2
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.require ) gpd Design flow provided 3 gpd
Plan Date 1 1.4 Number of sheets Revision Date
Title G
Size of Septic Tank c S.A.S.Type of
Description of Soil
Nature of Repairs or Alterations(Answer when applicable �7
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 Health. 1
Sigped, Date 11 /Z d
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. 2U t y 1 Date Issued /
-------------------------------------------------------------------------------------------------------------------------------- ------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS.
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Construdled( ) Repaired( ) Upgraded V )
Abando ed( )b
at �- (LJ�� as been constructed in accordance `
with the provisions of Title 5 and the for Disposal System ton truction Permit No.�d�) S If'dated I �2
Installer ( (SA40 Uc_:1I Designer
#bedrooms —3 Approved design flow gpd
The issuance of this ermit shall not be construed as a guarantee that the system w func ' n designed.
Date L Inspector ( ,
1
..,.�- ......>..�:-..:,.:.��. .> .:�..-.::tea,. ,� -. _. _. _._J...r.Wiz_:• _:_. =•=�'-------------._.N-sem
No. o - L 'L/ Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
t6posal bpstem Construction ermlt C ,r�
Permission is hereby grant e to Const ct( ) Repair( ) Upgrade Abandon( )
S
System located at C,16
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:Constructi f n must be ompleted within three years of the date of this permit. /
Date Approved by {/)r
Town of Barnstable
INE
CF Tp�
Regulatory Services
• w
Richard V. Scali, Interim Director
RN• BASSABLE,
N sy. `0$ Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: (19 7DI57 Sewage Permit# VAssessor's Map\P rce12011
Designer: D4W F? �QkcjCtxl In aller:
Address: DW-1 Address: CCM 1I
j On 12 ZZ �� was issued a permit to install a
j date (costa er)
septic system at ��� � based on a design drawn by
n 9 (address)
0 �, IM UV dated—I I 2
/ (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 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 Regulations. Plan revision or
certified as-built by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed in co nliance with the terms
of the IAA approval letters (if applicable) aF it
o� UAVII] e
s
(Installer's Signa N1 orl M e) � —,
- No.1066 a
S'tNI TAR\
(Design Signature)LtL' (Affix Desi p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
antE
Town of Barnstable P# /O
Department of Regulatory Services. (]
�nr,srARM: Public Health Division Date 9-2 /
.MASS 100 Main Street,Hyannis MA 02601
s
y 4j a
Date Scheduled � r t , Time U Fee Pd. �
Soil Suitability Assessm nt for Sewage Dis osal
Performed By:�1/►tom/�U/��� Witnessed By: ""' JAA
/ I
LOCATION&GENERAL INFORMATION N,x
Location Address /Cq/,� � �
� Owner's Name
6 ! Address
Assessor's Map/Parcel: 2%I l� Engineer's Name t i"I NEW CONSTRUCTION /REPAIR Telephone# - r61
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line It Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
I
� I
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing 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 Adj.Groundwater Level_
PERCOLATION TEST Date Time
Observation
Hole# Time at 9"
Depth of Perc Time at 6"
Start Pre-soak Time tQ+ - Time(9"-6")
End Pre-soak
Rate MinAnch `
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
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 Conservation Division at least one(1)week prior to beginning.
Q:\SEPTICIPERCFORM.DOC r
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,% ve
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i/ flog
t
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
-41
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate May:
Above 500 year flood boundary No_, Yes
/
Within 500 year boundary No �Y YYes_
Within 100 year Flood boundary No V Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in a azeas observed throughout the
area proposed for the soil abso lion system?
If not,what is the depth f na Ily occurring pe o aterial?
Certification
I certify that on io 4� (date)I have passed the soil evaluator examination approved by the
Department of Environr ientaI
rotection and that the above analysis waTperfied b meconsistent with
the required paining,ex esc bed in 310 CMR 15Signattue Date7 (t l�
Q:\S EPTIC\P ERCFORM.DOC
ASSESSORS MAP:
29 ---______ —,_-___-_ TEST HOLE LOGS
PARCEL: � q
_-___ ----------- -- 1) The installation shall con)1A with 'l'itle V and 'I'mvn oI'?lwyWjI oard of
FLOOD ZONE: L7 _ _ SO I L EVALUATOR DXVID�. I lealth Re ulations.
�0( -� —! I_ - --- WI TNESS -2 V 1 2) The installer shall verify the location of utilities sewer inverts and septic
REFERENCE. y
_._._.. DATE: 51q' 1` Z components prior to installation and selling base elevations.
,L,Iw� G'� 4 � �� -� PERCOLATION RATE: 0- , /Al, 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per loot. "The first
--- --- - _ 1— two feet out of the d-box to the icachin shall be level.
____�7 ___._f __..__ .. _' __-- ---' �� :--(-'-'�-- 4) 'flies plan is not to be utilized for property line determination nor any other
> — TH- 1 TH 2 purpose other than the proposed system installation.
f�1,,1..... 5) All septic components must meet Title V specifications.
10 _ 6) Parking shall not be constructed over If 10 septic components.
Av (fqAlo p 7) The property is bounded by property corners and property lines.
.,G ��jc� .1 8) The properly owner shall review design considerations to approve of total
LOCATION MAP 3�! - �i;5 .- ?j5 design flow and number of bedrooms to be considered for design. Receipt
I of payment for the plan and installation based on (lie plan shall be deemed
,� � �' approval of the design flow by the owner.
� `��`"I f-1 C; 9) The existing leaching or cesspools sliall be pumped and filled with material
7� Z"Vff 7 "Z' +7/c.� per Title V abandonment procedures. Those within the proposed SAS shall
(�� 7 ► / be removed along with contaminated soil and replaced with clean sand per
Title V specs.
41Q10)System components to be 10 feet (rota waterline. Sewer !:nes crossing the
- ` - - �- water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if
`t'624--�- applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
SEPT I C SYSTEM DES I GN 1 l) If a garbage grinder exists it is to be removed and is (lie responsibility of the
1 Y
owner to ensure such.
FLOW ESTIMATE 12)The installer is to take caution in excavation around (lie gas line ifsucli
exists.
(� 13;)"Foe installer shall verify the location, quantity and elevation of the sewer
BEDROOMS AT GAL/DAY/BEDROOM - � GAL/DAY Y 1 Y
p lines exiting the dwelling prior to the installation.
\ SEPTIC TANK 14)Titis plan is representative only that a system can fit on a property meeting
--- "Title V requirements.
o
aQ�GAL/DAY x 2 DAYS GAL
UUSE 1� GALLON SEPTIC TANK
SOIL ABSORPTION SYSTEM
DAVID
1 .__ SIDE AREA. 2X zo / 13. �c
BOTTOM AREA: 01) br-7 .35 I MASON R;
I 0 No.1066�0
I SEPTIC SYSTEM SEC
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SEPTIC TANK
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0 �_ _��► -- SITE AND SEWAGE PLAN
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LOCATION L� YE
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M PREPARED FOR : � 2 ?Ila
a SCALE: '=ZQ
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DAV I D B . MASON R& DATE: U
DBC ENVIRONMENtfAL DESIGNS
EAST SANDWICH . MA
DATE HEALTH AGENT
( 508 ) 833- 2f77