HomeMy WebLinkAbout0104 CHESTNUT STREET - Health 104 Chestnut Street
Hyannis
A = 309 048
i
TOWN OF BARNSTABLE
LOCATION CI't-,ZAILC SEWAGE # ��A►►
VILLAGE � � r ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. I M&OZZ& — `.c
SEPTIC TANK CAPACITY ��GI� -� (0 Z�z
LEACHING FACILITY: (type) Q I&V,(;goo* AD MaX-Z
NO.OF BEDROOMS
BUILDER OR OWNERAttq
PERMTTDATE: ��—Oq COMPLIANCE DATE:`
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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LOT NO. : 1Ocj ADDRESS :_CM65—To,3u— T� �
OWNERS NAME
SEWAGE PERMIT NO. :S--'J-'RC6 NEW: ,REPAIR:
DATE ISSUED: DATE INSTALLED:
INSTALLERS NAME: 26V4CP- Zogea
INSTALLATION OF:
- WATER TABLE: FINAL INSPECTION BY:
DRAWING OF INSTALLATION ON REVERSE SIDE : ���� �
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00 NO. THE COMMONWEALTH OF MASSACHUSETTS R ffEE j 4
BOARD OF HEALTH
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair (4/) Upgrade ( ) Abandon ( ) - []Complete System []Individual Components
/®4L c %sue� r # Nam &Me-,
IV Location Location Owner's Name
3pqMap/Parcel# Address
Lot# � � Telephone#
v/ya•t�-/u r /V el
i. Installer's Name ' Desiggers/��//7
Address Address
Telephone
# Telephone#
Type of Building: Lot Size Sq.feet
Dwelling—No.of Bedrooms ? Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd
Plan: Date Number of sheets Revision Date
Title
Description of Soil(s)
Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further at rees not to a the tem in ation until a Certificate of Compliance has been issued by the Board of Health.
Signed to
�S 1Z ,
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
1
'� 'r -"�„�, ,F,,�-r, s.. ..-,. - --,-w"�--.-^r.F q•n'r-*" - -;,,.�. ^„. -..-�v� `;----mow wFr-j'�;.r.�Yy:r3 �.._. .. .
.1�
THE COMMONWEALTH OF MASSACHUSETTS Tt 7tE �G
BOARD OF HEALTH $
Q6_oC X1'#' OF
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
-Application for a Permit to Construct Repair rade Abandon
pp ( ) p ( pg ( ) ( ) - El Complete System ❑Individual Components
( LL /,/�� / / y-^
_ Location LIYAiy )) �QT �!/G-5 - �'7146 e S/
1 ,
Map/Parcel# Address
Lot# Telephone#
Installer's Name Desi
ad 11 64ROA G/A AI,2Sm 41aLs ! �fA;w sr', g Vic►?f
Address dress
fqW
Telephone# Telephone#
Type of Building: Lot Size d' Sq.feet,
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures
Design Flow(min.required) gpd Calculated design flow gpd Design flow provided gpd
i. Plan: Date Number of sheets Revision Date
i
Title
Description of Soil(s)
f, Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation
� DESCRIPTION OF REPAIRS OR ALTERATIONS
1A
WI I
r The undersigned agrees to install the ab�ve described Individual Sewage Disposal System in accordance with the provisions of
^ TITLE S and further agrees not Ito*111-Ace the Z.
in operation until a Certificate of Compliance has been issued by the Board of Health.
Sigtie.d ateYJ
v
1 v , C
v t
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
r
NO.2[it/Z Z?S THE COMMONWEALTH OF MASSACHUSETTS FEE
BOARD OF HEALTH CERTIFICATE OF COMPLIANCE
j,. Description of Work: ❑ Individual Component(s) ❑Complete System
The undersigned here boy certify that the Sewage Disposal System;Constructed( ),Repaire4upgraded( ),Abandoned(at )
y
has been installed in accordan ewith hUe�p ov> of 310 C R 15.00 (Title 5) and the approved design laps/as built
plans relating-,toful application No.�� daT�d F/"-7/_L "Approved Design Flow (gpd)
Installer ��Designer: And e Inspector —T�-�C:./O � ^s�`'`^+ Date
i � G i f
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF:COMPLIANCE DEP APPROVED FORM 5/96
No. CEO THE COMMONWEALTH OF MASSACHUSETTS FEE
r
;hl. ,�f/11 BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
Permission is her b g nted tto Construe epajr : Up grade ) Abandon ( ) an individual sewage
disposal system at , > & ) as described
I, y
in the application for Disposal System Construction Permit No. dated
Provided: Construction tfl be c mpleted within three years of the date of this permit. 1119cal conditions must be met.
Date / Board of Health/
� r
FORM 2 - DSCP DEP APPROVED FORM 5/96
�� FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM -PUBLISHERS- BOSTON
t
TOWN OF BARNSTABLE
LOCATION ���' P ���� ��' .
SEWAGE #
VILLAGE f�l¢h' ASSESSOR'S MAP
&,SLOT
INSTALLER'S NAME&PHONE NO. d = '
SEPTIC TANK CAPACITY 1��® '� 607 OZ
LEACHING F�kCILITY: (type) C
NO.OF BEDROOMS _
BUILDER OR OWNER
PERMTTDATE: ,5.:7 bf COMPLIANCE DATE: ''/lif2q
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 Feet .
on site or within 200 feet of leaching facility)
i Edge of Wetland and Leaching Facility (If any wetlands exist Feet
within 300 feet of leaching facility)
Furnished by
94
� Lir6
®080L
MAY-17-2004 09 :50 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01
Town of Barnstable
4 Regulatory Services
t Thomas F. Geiler,Director
` Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis,MA,02601
Office: 308-862-4644
Fax: 508•790.6304
Designer Certifi tion Form
Date: 5
Designer:
Address:
On ---BRA as issued a permit to install a
(date) (installer)
septic system at I o C4.4 S based on a design I drew,
(address)
dated
.. I certify that the septic system referenced above was installed substantial)
�k
according to the.design, y l.c ► o�M p T �.rt � a��. yr N V1,,
I certify that the septic system referenced above was installed with changes but in
accordance with State & Local Regulations. Revision or certified as-built by
designer to follow. -
ARNE
QJAt.A
CIVIL H
No. 30792
(Resign is ignature) (Affix re)
PLEASE RETURNT11 IFIAIIINqrPAUTP PT7D LIC ALT Vi
TJ TE ONIP ANCE WILL NOT BE I UE Q 'H THIg-
RM D A UILT AR l2 IVED BY TIM BARNSTABLF,
PUBLIC HE TH DIV[SIO
Q:He4thleptic/Daigner Certitfaat on Form
�oFtTw,ti Town of Barnstable
Regulatory Services
• MMS"UB
9�A ,e$ Thomas F. Geiler,Director
'Eon° Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Designer Certification Form
Date: S �S
Designer: -
Address: All
t
On was issued a permit tolinstall a
(date) (installer) v
septic system at 1 o , based on a design I drew,
(address)
dated N—
I certify that the septic system referenced above was installed substantial)
j accordingto the desi y
�� ¢��-r Nor �� a►2�p., ' N>�� sfl�.S
I certify that the septic system referenced above was installed with changes but in
accordance with State & Local Regulations. Revision or certified as-built by
designer to follow.
i H OF AgySS9
ARNE H. oyGN
OJALA
CIVIL
4 No. 30792
5 T E'�G���
S
(Design is ignature) (Affix re)
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:Health/Septic/Designer Certification Form
_s-
Q 1
THE COMMONWEALTH OF MASSACHUSETTS
i
BOAR® OF HEALTH
..................... .... .........•--..OF..... ................"I...I......
Appliratilan for R,gpnii al Marks Tomitrurtinn rtrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: `
.....-1 <'�—` �'�''•`�e S ovv ..�,�S�.------------------- ------------------------------------- ` ................................................
Location-Address or Lot No.
W — :� .. O I ' e..�..... .! de Address
Q Type of Building Size Lot............................Sq. feet
aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
QOther 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 ( )
Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit-----............... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
C4 -•••--••-•••-•----------••-•--••-••••••--•-••••--•-•••----•••......--•-•----•-----•...----•-------.•--•............................•-•.................-----
0 Description of Soil........................................................................................................................................................................
x
U
W
.---------•--------------------------•---------------- -------------------------------•--------------------------------------------• -••••--•••---••-•-----•-•••-•--•-•-•......-••--•--------------••-
V Nature of Repairs or Alterations—Answer when applicable..-__1920P.....ti-.c�..v..` f��I. ..........� _----__.
•----------------------------------•-- 1 aQo s'4--------•---•.G ..`-(.0....--..................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TLN!Z- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ed by e boar �h.
Date
ApplicationApproved By......... .--•-• •-•------••--•--•---------------•-••--....-----.-•---
Date
Application Disapproved f o the o owing reasons--------------------•----------------------------------------------------------------------------•-•----......._
---------•----••••-----•-----•-•••-•--•...•---••----••---•-••-----•--••••-----•--•---•••--•--------------•••--•-•--••-----••-•-•-•--••••--•-••-•---•------•---•-••-•-••---•••••------•--••--••-••••-----
Date
PermitNo......................................................... Issued.......................................................
r"
No, yev
- F
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................... ....................OF.....................................
...
ApplirFation for Uiipootal Works Tonotxnrtion Vautit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
\-;;.c u: (...... .........................•_.... ••------•-•••-----•--•-------...............--
e- / Own ---..,, �� Address � ..^�
a ........... ._:_.: � ' =e.....�' 1. ! .'� _` r e.:a11.! :•J '.•.••
Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
d 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........................
fX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 .•-----•--------------•---•---•------------------•---------.....•--••---.........••.......--•-....••.........................................................
0 Description of Soil........................................................................................................................................................................
x
U •-•--•----•-•-•-----•-•-•----•------------•--•-----••--••--•---------------------••---......-•----•-•-------------------------•-••----------••------------------•---•--•••-•---....------•--•----------
w
U Nature of Repairs or Alterations-Answer when applicable._.__J_f�G .....tj QP------T.A_._�;_.____._...
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ed by e boar lth. /
Date T
ApplicationApproved BY.............. .......•-••-------...--•-----•--•---•--•----.....---......._......•----........
Date
Application Disapproved f, th owing reasons---------------•---------------------•-----------------------------------------------------------...------....._
. •-••-••-•---•-••-•---•......----•-•---•-•-•------•-••--•-•--•--•-•-
Date
PermitNo--------------------------------------------------------- Issued-.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF....................................................................................
T a of irFa#r of Tomph anrr j
T == S T_ CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �- ..
by / ......j-------- ----------------------------------------------------------•--•--••----------•--------------............-------------•-•-••-------•------
-C . / Installer
has been installed in accordance with the provisions of T_ .TIF 5 of The State Sanitary C e s d 'crib d in the
application for Disposal Works Construction Permit No.. ________________ dated .._- .l _._ _..._____.._...
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A ARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. y�
DATE..........................................................% (�"8.L.._.. Inspector.........---------------------•--•--•--------......—
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
(1 f � 0 ...........................................OF.....................................................................................
No.......................... FEE../..................
io oottl o ' ,.g Tonot nr$ion rrntit
Permission is hereby granted.......per°"`f !__ _______________._
--------------------------------------------------------------------
-------------
to Construct ( ) or Repair ( an idual Sewage Dls osal System
as shown on the application for Disposal Works Construc io Permit tNo--------- ._ ------ Dated.......................................
DATE............................................................................... Board of Health
FORM 1255 A. M. SULKIN, INC., BOSTON
7 LOT NO. : . 1� ADDRESS: C' A �TiJu'c vT�
OWNERS NAME:
S GE ,PERMIT NO. :2� - Db NEW:_y.REPAIR:
DATE ISSUED: DATE INSTALLED:
INSTALLERS NAME: Vim ,
INSTALLATION OF: Clop G 1 l
WATER TABLE:` FINAL INSPECTION BY:
. DRAWING OF INSTALLATION ON REVERSE SIDE:
ST Ko,,s� ev
39' ''!14 i s
.S�PiICC. r
I
TOP FNDN. AT EL. 45.1'
SYSTEM PROFILE TEST HOLE LOGS
EXIST. STEEL COVER TO GRADE (NOT TO SCALE)
ELEVATION 44.2' PROVIDE INSPECTION PORT WITHIN
ACCESS COVER/ (WATERTIGHT) TO 6" OF FINISH GRADE LISA LYONS, RS� ENGINEER:
MINIMUM .75' OF COVER OVER PRECAST /` WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM
43.0' WITNESS: DAVID STANTON, RS LOCUS
2" DOUBLE WASHED PEASTONE 4/29/04
RUN PIPE LEVEL DATE:
EXISTING 1 f FOR FIRST 2' ' PERC. RAT - I 0 E _ / 3 MAX. E _ < 2 MIN/INCH
,t GALLON SEPTIC7\40.7(Y* 40.840.9 ' CLASS I SOILS p# 10694
TANK (H- 2O ) GAS
' - BAFFLE 40.08' m C1 0 0 0 0 E1 1-1
40.25 Q 39.95' � aCIO ED DIOCJ [� Fs
6" CRUSHED STONE OR MECHANICAL 0 0 4 ELEV•
COMPACTION. (15.221 (2]) g 2' � 0 E ED 0 = 0 [� Cl7�� 0 37.95' ��� 43.4'
DEPTH OF FLOW 4 ( 1 �; SLOPE) ( 1 ib SLOPE) A
TEE SIZES- 3/4 TO 1 1/2" DOUBLE WASHED ,STONE LS
INLET DEPTH = 10 9" 10YR 3/3
OUTLET DEPTH =
14"
B LOCATION MAP NTS
FOUNDATION- EXIST. SEPTIC LEACHING LS.. TANK. 39' D' BOX 15' FACILiiY 5• ASSESSORS MAP 309 PARCEL 48
25 31" 10YR 4/4 40.8'
*THE INSTALLER SHALL VERIFY THE
LOCATIONS OF ALL UTILITIES AND ALL
BUILDING SEWER OUTLETS AND ELEVATIONS
PRIOR TO INSTALLING ANY PORTION OF C
SEPTIC SYSTEM
PERC
32.7' MS
42.5
\
\ 2.5Y 5/3
\ � + 42.7
42.2
BENCH MARK -- CORNER
-0F CONC. PATIO EL=44.0 4�.2
42.7 \ 12800 32.7'
(_ EXIST. 1000 GAL. H-20 A-a3.9 \ NO WATER ENCOUNTERED
SEPTIC TANK (RE-USE)
I N�9 PUE� pR� - 42.0 NOTES
`SEPTIC I __Y, n oc,n., .._!'!C
43.8 4 a \ ''� DESGN. (GARaocE`DlsPosER IS_�4_T�►.�.OWEO ) 1. DATUM IS ,.P� ,,.,.., .ID .._ - _-....
6" 2. MUNICIPAL WATER IS
i 3.9 0 \\ DESIGN FLOW: �.3 BEDROOMS ( 110 GPD) - 330 GPD EXISTING
a 0 44.0 16" OAK FUSE A 330 GPD DESIGN FLOW
16 OAK
0 �? 1 - 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
44.2 44.E 44.0 \ y _ ASEPTIC YANK: 330 GPD ( 2 `) - 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H 10
'r
12" OAK a �/ `t \ RE-USE EXIST. ]QQQ GALLON SEPTIC TANK 5. PIPE JOINTS TO BE MADE WATERTIGHT.
43.9 41•5 ,LEACHING: 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
GRPv 44. \ --- ENVIRONMENTAL CODE TITLE V.
+ a3 44.0 + 439 \ SIDES: 2(30 + 9.83) 2 (.74) = 118 7. THIS PLAN 1S FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
i 3.8 TWIN coQP�`0 4 .6 \ r 30 x` 9.83 (.74) - 218 TO BE USED FOR ANY OTHER PURPOSE.
14 OAKS \ 30TTOM: 8. PIPE FOR_ SEPTIC SYSTEM. TO SCH. 40-4" PVC.
+ 6" TREE l TOTAL: . 454 S.F. 336 GPD
43.9 EXIST. DWELL. 1 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
\ NYSE (2) 500 GAL: LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
41. TOP FNDN � 45.1' O � FROM BOARD OF HEALTH.
/� \ EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5'
TREE 'CAS UTj�T� 41.5 1L3ETWEEN UNITS 10. PUMP & REMOVE FAILED LEACH PIT.
ti £s
44177 REMOVE ALL CONTAMINATED SOIL WITHIN 5 OF NEW FACILITY
+ 41.8 9<� 3 + 6 AND REPLACE WITH CLEAN MED. SAND
J, �pO o LOT AREA y,PJ' a1.3
o�� •o� 43.7 12,367t SQ. FT. G �� LEGEND
TH , TITLE 5 SITE PLAN
W gp�� 100.0 PROPOSED SPOT ELEVATION OF
41. \ 104 CHESTNUT STREET
1.6 p��+� 41.1 10Ox0 EXISTING SPOT ELEVATION IN THE TOWN OF:
^r�1`'
a 100 PROPOSED CONTOUR
31.42' ,,�•�� ( HYANNIS) BARNSTABLE i
=20,00' �� CJ�1� 100 EXISTING CONTOUR PREPARED FOR: NOELA BERRY
SQ\AP
P 41.3 20 0 20 40 60
41.0 41.0
_ BOARD OF HEALTH
MA SCALE: 1" = 20' DATE: MAY 1, 2004
APPROVED DATE
4
off 508-362-4541
fox 508 362-9880
n26
dOWn cape engineering, lnC, \AOFMgSs'CI�/IL ENGINEERS o� 7RNH.LALAND SUR�/EYORS L Cn
939 rain st. yarmouth, rya 02675 .�
-f._ OJALA P. .» ----- --n A T-F