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HomeMy WebLinkAbout0077 DUNN'S POND ROAD - Health 77 DUNN'S POND ROAD Hyannis A = 249 — 098 f� i i e z o -^� T TOWN OF BARNSTABLE — LOCATION I / D o N#41 PD O jP—b SEWAGE# 2—t I VILLAGE v s /-/G� ASSESSOR'S MAP&PARCEL 2y — O�( $ INSTALLER'S NAME&PHONE NO. Sok/7.324312 SEPTIC TANK CAPACITY t s—bo Q►a�a LEACHING FACILITY: (type) Z C,4A-016e7Z. (size) ,GG 5-00 NO.OF BEDROOMS -3 OWNER PERMIT DATE: /0 - Z- I ` 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) G )D Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) v Feet FURNISHED BY Q- HDLC. � �' +') � �.� � � � , _ � � � rl � � d � �- ,� � ___ y No.02GI q _J 66 ! FEE 'Mt) COMMONWEALTH OF MASSAC14USETTS Board of Health, $A OT—APt , MA. APPLICA1 N FOP DISPOSAL SYSTEM CONSTRUCTION PERMIT -7-7 15"w_S Application for a Permit to Construct( Repair( ) Upgrade J Abandon( ) - 'icomplete System ❑Individual Components Location Owner's Name p V\ Map/Parcel# © 9 Address) r y. Lot# 3 �— Telephone# Installer's Name _ ,-10�,� Designer's Name l Address q ' AddressI'k - R04 Telephone# a� ,n� 3�-- Telephone# _ y Type of Building S ) �!�� l' 1� 1 Lot Size � ) 4 sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( }� ) Other Fixtures J , Design Flow(min.required),�tl© gpd Calculated design floor Design flow provided gpd Plan: Date �� Number of sheets Revision Date ,�1 Title �� p,I Description of Soi (s) d`j© S� 6z, A\ '1 'ZD Soil Evaluator Form No Name of Soil Evaluator a _ �� Date,6f Evaluation 1 , DESCRIPTION OF REPAIRS OR ALTERATION _- L - �Z )- The undersigned agrees to install a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further afire to not to place tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections N ,`�G! (,� �. �� :r� � .� �- _ _ 'lam No.(/ 1 _ c FEE l 9 �. COMMONWEALT14 ®F MASSAC14USETTS � Board of Health, MA. APPLICAT .N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT ' 7-7 to l h'S 6),t> J Application for a Permit to Construct( ) Repair( ) Upgrade(O Abandon( ) 1) Complete System ❑Individual Components Location Owner's Name Oft Map/Parcel# Address N xi Lot# ''-Telephone# Installer's Name,j )- C L` Designer's Name C ' Address (� 'Y . 1 \ Address j'k Telephone# a7- J Telephone# Type of Building'' r (1) 1..z' 1~ 1A 1 3q Lot SizeZ' y )I OZ� sq.ft. , Dwelling-No.of Bedrooms Garbage grinder ( Other-Type of Building *r ! 'Y No.of persons Showers ( ),Cafeteria( ) Other Fixtures / , 1 Design Flow (min.req`uired.)� © gpd Calculated design flow-l*� Design flow provided�gpd a Plan: Date Number of sheets �. Revision Date Title +.� •r►� ~' ► ► P� J Description of Soils Soil Evaluator,Form No, ' Name of Soil Evaluator 6 , L D"a"te;LEvaluation,-{ -�� ► DESCRIPTION OF REPAIRS ORALTERATION tk 1.-'S�0 ) Ana The undersigned agrees to install a above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agre to not to place tem in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Inspections No. tJ FEE r6-0 ¶' 1 Board of Health,"7"���� �f 0*^�L•L . MA. CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) Complete System The under ereby certify that e Sewage Disposal System; Constructed �),Repaired ( ),Upgraded ( ),Abandoned ( ) by: at V I� has been installed in accorda�jce with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No..2 L4 4 G6 dated /0'-2 -f(-f Approved Design Flow ��t *3v (gpd) Installer 4/ A vc-- Designer: Inspector: // v k �Date: /S✓ The issuance of this permit shall not be construed as a guarantee that the Ot em willlfunction as designed. No. �G( 1 � FEE / C®MMONWLALT14 OF MASSAC14USETTS Board of Health,%PN� MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Constructy) Repai ) Upgrade( ) Abandon( ) an individual sewage disposal system at as described in the application for Disposal System Construction Permit No.90W-M ,dated Provided: Construction shall be completed within three years of the date of this permit. All loc , conditions must be met. c— Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date y�l Board of Health w-✓�/� - 7 Town of Barnstable Regulatory Services P e; Thomas F. Geller,Director HnffivsrABM - 9 MASS. Public Health Division s639• �� �'ATeo r�'t°' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Dat�. Sewage Permit#f� l`t-�1Z Assessors Map1Pa rcelC' � JO 1 Designer: Installer: � �Address: ` " b ^ dress: 9 1A t y I` 1 � Ad � D\1 was issued a permit to install a (date) (installer) design septic system at � l based on a d gn drawn b Y (ad dress) dated - f (designer) v certify that the septic stem referenced above was installed substantially according to I fY P Y the design, which may include minor approved 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.el 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. �y r�"OF�;1RSS� ;�� / ;FFtffit2Y ycy�, WARL S', (Installer's Signature) _ � �;r,1fR, 1 Jko.26$7`v,� ._ .�SS�ONAL e (Affix Designer's`"Stamp Here) PLEASE RE TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY TBE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:HealtvSeptic/Designer Certification Form 3-26-04.doc �V� Town of Barnstable P � Department of Regulatory Services , t ]Public Health Division ASS ba M te r� A 143fp. t 200 Main Street,Hyannis MA 02601 Date Scheduled— T1me � � .� Fee I'd. Soil Suitability Assessment for Se e Dispos p Perfbrmed.By: Witnessed By: LOCATION& GENERAT,INFORMATION Location Address '. C1 Owner's+da -- fo ddress Assessor's Map/Parcel: Engineer's Name: N>, Ly rV NEW CONSTRUCTION REPAIR , Telephone it . Land Surface S Use 1 c� � V ��. O Slopes(96) j tones Distances from: Open Water Body 5 ") ft- Possible Wet Are y CICj ft Drinking Water Well Drainage Way W ft Property Line Other ft SKETCH:(Street name,dimensions of lot,exact locations of teat holes&pere tests,locate wetlands in proximity, to holes) Z2: - C�. , �1 } Parent material(geologic��� �T Depth to BeQrQclp_•�„�1� a Depth to Oroundwate'n StandingWater in Hole: }-a, Weeping i1•oln Pit Filed Estimated Seasonal High Groundwater �r R DETERIVUNATION FOR SEASONAL HIGH WATER TABY.,ia Method Used: Depth.Observed standing in obs.hole. In, Depth to soli mottles: Depth to weeping from side of obs.hole: In. Ortlundwater AdJustment fr. Index Well# Reading Date: Index Well level Adj.thctor- Adj,Groundwater Level PERCOLATION TEST bate 'IYmu 1 M e Observation Hole# ✓� Time at 9" Depth of Perc Time at G" Start Pre-soak Time @ Time(9"6") End Kc-soak ' Ra[e Miu.11nch Site Suitability Assessment; Site Passed Site Failed: ' Additional Testing Needed(Y/N), Original: Public Health Division Observation Hole Data To Be Completed on Back V----- ***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 DEEP-OJBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Sol[, Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,.Stones;Boulders. onsistency %'Gravel) c5 es.J �) -------------- DEEP OBSEIBVA.TIO �N l`IOLE LOG mole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ra ).Lo DEEP OBSERVATION BOLE LOG hole# Deptir'from Soil Horizon Soil Texture Soil Color Soll Other Surface(in_) (USDA) (Munsell) Mottling (Stiucture,Stones;Boulders. Con i to c Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil horizon Soil Texture Soil Color Soli Other surface(in.) (USDA) (Munsell) Mottling (Structure,Stolres,Boulders, Consistency: Gravel) a Flood Insurance Bate Man: Above 500 year flood boundary No Yes Witidn 500 year boundary No_ Yes `r Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pp io,�ts terlal exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of haturally occurring pervious material? . Zt1 Of Ceftification �s\' I certify that on o. e assed the soil evaluator examination approved by the Depart viro o tal tion tt at t above analysis was performed by me consistent with . the rC i ' fic ex . i e crib in�10 CMR 15.017. 09 Signature ��s E a� Dat, C Q:\S.RPT1CkPERCF0RM.D0C , �- ir�.GF2 > L 4�0 C��fADk r7.�3 Q , �X1 S�•l NG G , ----- . _ �- i —2' �Ev E� 61r M i rJ./3 M Ax C oV OT�ST �p G/>��NtV+I !IF: PR,LEVI E� _ C. GoN G. MAI �CQu�`�•.a4 d 4 f3 ..._ .. _ C�"Cf2u9riA STaNC 'DR Cc�n�tt\ci tt-Jgj-C -- ���r, s� E LOG U 5 DCr) k o • S �q>v,1> NOTES: 1. Disposal System to be constructed in strict accordance with — __ Commonwealth of Mass. Environmental Code Title V. 2. This plan is for the sole purpose of construction of a septic system. I 3. Contractor to call Dig-Safe 72 hours prior to beginning of excavation. 4. Pump out existing pit, fill with sand and abandon. x 5. Contractor to field-check invert at foundation. - 6. Bench mark is top of foundation - Elv. 49.0. `+°' 7. APN is 249098 for the Town of Barnstable. 8. Locus is served by Town water. 9. The plan view is based on L.C. plan 10614-E recorded at Barnstable Reg. of deeds. 10. Use a new 1,500 gallon H-10 septic tank; install Tees and gas baffle - Cper Title V. 11. Use 2 — 5 x8 x2 H-10 leach chambers with 4 of / to 1 / 'bouble TT L13T 1 > washed stone all around with filter fabric on top. I - 12. Call engineer for as-built measurements before back filling system.CU ; i I - 12. Grade, loam and seed disturbed area. L7n , �o• r J, o,o M _ _..,_ ._ w. __. . _. EX IT/h� �u OF 7�6AD' P AS 0�' �1yDY 1 0A � i rJARR _yT. EAR RA i L,<,' t�1)t1 —�S,+S L ,7E- , JR, a J�1 I\ LJ ill 4"1 .b �D�L. L.d._I NJ f_i W/ 3 F3 E D \U 0 M 5 5 C_/A L � a _--_ — - _ — �o � sz ITN cTAI i cv� 7r10M�\ ZY. RUH 61 �.E Rf T'l� i`�14'� �' �' , Y�w 1`J E.�J i � t _.El\CI1lNG J `Y. I . 1-\ S 5 Z - x x _ 0 U !'�t,. t, O t R Tom. U S 5 b' Z RC, L, C.+ 4 aTJOC`JE Io � �I`lANN t � nA � LXI 1ftlG CON 1 UJ� I r y T' O T i�,L,. C/��1� -Fe sr E Q �9 2��-a�• C 0 I�l SV L i C 1�..� �, . .�, N D��MA &�c�Ne.�/� �,�Tf-QRAWi�i�R.S, DATE - 1 1