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Home My WebLink About0180 DUNN'S POND ROAD - Health 180Dunn's�Pond Road � ,ry 'a',#� _ ,.'" " 7;3 r" rnu b# a9a " Next �51. Hyannis ` ; , � A=,270`- 0 I I 0 i '. TIM Town of Barnsf able P# -Department of Regulatory Services grABLA i Public Health Division Date i � �. , p 1639• ,p� 200 Main Street,Hyannis MA 02601 n rF0 MAC t. tv Date Scheduled i �P Time rn Fee Pd, Soil Suitability Assessment for Sewage Disposal m t� r Performed By: ' rQ �Tl"1 �i✓L. -1 Q S�`/ �Z Witnessed By: __0_ L/- ✓f Location Address LOCATION & GENERAL INFORMATION n , 09 CL Yl> S �OvL-Or t. (tom, Owner s Name /`-L(Cj+ 1.U,/v�L_ 10 ' 1 (rd�✓! 1 Address 1 �� Pi1:, A is PI d�I Assessor's Map/Parcel: Zr. 0 .- W O" 0,Q � i Engineer's Name 4yepl l d' �''r9 r'•i.�er'y`�S j ��.C. NEW CONSTRUCTION REPAIR Telephone# •$-C-0_-73 r7— V 6 9 Land Use �es l CL&L.+t c, I tt 2- ' I Slopes(%) I ' Surface Stones Distances from: Open Water Body.? ft Possible Wet Area 2 ft Drinking Water We117"-S f" ft Drainage Way /J,//1, ft Pro ert Line Other-- SKETCH: Y �� ft Other j SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i 2 , I j Parent material(geologic) Depth to Bedrock �L/ A-/ Depth to Groundwater. Standing Water in Hole: /V6'`QWeeping from pit Rttee _r Estimated Seasonal High Groundwater_ -1 2-6 [r 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 -T F Index Well# _ Reading nave: _ .Index Well]eve! A:]j.Groundwater Level— PERCOLATION TEST Dtlte e. Time..��, FHIe rvation # 1 ' ( _ �i��C/ Time at 4" epth'of Perej �(cr2l Time at 6" Start Pre-soak Time @ _ Time(9"•6") End Pre-soak _ Rate Min./Inch, Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) 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:\SEPTfC\PERCFORM.DOC j ]DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other_ Surfaci (in.) (USDA) (Munsell) Mottling '(Structure,Stones;Boulders. Consistency.%Gavel - 6 2 -37 •r. :DEEP OBSERVATION HOLE LOG Hole# 2 Deuth from Soil Herizen Soil Texture Soil Color, Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. IConsistencv.%Gravel) YZ— yq (2-6 _ C 2 Y V Y ]DEEP OBSERVATION HOLE LOG Hole# Depth!om Soil Horizon Soil Texture Soil Color Soil Other Surfacl(in.) (USDA) r (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) I •. r 'DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon , Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistency.% rel) I r Flood Insurance Rate Maw � Above 500 year flood boundary_ No r,_/ Yes Within 500 year boundary No '� Yes,,,„ r Within 100 year flood boundary No Yes Dent of Natu><-ally_Occurring Pervious Material Does at least four feet of naturally occurring pervio s material exist in all areas observed throughout the area proposed for the soil absorption system? �� _— If not,what is the depth of naturally occurring pervious material? Certification54f`i I certify that on _ 't 1 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tr ' ,expertise and experience described in 310 CMR 15.017. Signature � �.=--tw�.i. :Date r<'6 Q:\.SB IClPERCF?ORM.DOC LOCATION SEWAGE PERMIT NO. lid • �u��rs /� �� — VILLAGE 1S ` INST LLER'S NAME i ADDRESS -- , 4 ao R O OWNER Y c zwo Y� DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ,1 ,��_ �� 7 ��` �. I _ � , TOWN OF BBA�R�N�STABLE U ATION 3 �� ®�G[ /mil SEWAGE # VILLAGE A ��'�I o// S ASSESSOR'S MAP &LOT 7JO-®03S INSTALLER'S NAME&PHONE NO. 16orr0ZP 704) SEPTIC TANK CAPACITY �y ,2 ir-,* es o 'f w i FT LEACHING FACILITY: (type) � ��`��"0 ize) Slow-e und+,t 1 FT 7 NO.OF BEDROOMS 'a) BUILDER O �bo)VNE PERMTTDATE: Z® J COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 . t v� N ' I II. � 0 s TO �OF B ARNSTABLE HOC°ATION ��%C,IJ'a % J�f ` CSC/ SEWAGE # VILLAGE , ASSES S SO '�SESS MAP&L T " -=Si:� AME&PHONE N /'f �U➢`�/ �I�CS SEPTIC TANK CAPACITY ,� a/ LEACHING FACILITY: (type�_.19/i` aGT015 %Q/ (size) T/e-iXA-'- 6� NO.OF BEDROOMS 4Z BUILDER1 R OWNE PERMITDATE: 716) COMPLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table and 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 3000 feet of le c761 f ciil Feet Furnished by i 1 97S kA, ,e I �� o � i r1 TOWN OF BARNSTABLE LOCATION l��= un �6I� 6 0--o/ SEWAGE # VILLAGE ye2121211 Ss ASSESSOR'S MAP & LOT s�Gc7t5RNAME&PHONE NO.20r2k1d�K-4' �cS SEPTIC TANK CAPACITY /� J LEACHING FACILITY: (type) [�P / (size) NO.OF BEDROOMS (�1 BUILDER OR OWNER ��C�/ae/ Q/1?21774 1`S PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 19 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /1 GC7to. Feet Edge of Wetland and Leaching Facility(If any wetlands exist � / within 300 feet of//leaching fa ' ity) 116nP_ Feet Furnished byG! �� C>. �. � r '. ((�� % �. --___` ,.p �a /� c J t� „__ '; .�., i Nog old Fims.............................. THE COMMONWEALTH �OFUMASSACHUSETTS BOARD ®1� �1 ..------�t'�'1..........-.OF............. � .. �i ................................ Appliration for Uiipnml Works Tnnitrnr#iun Prruat Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -. .Location-AddressNo. Owner Address ......................................... / Installer Address Type of Building Size Lot............................Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' 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 ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit------._............ Depth to ground water........................ rZ4 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R+ •--•----•-------------------•-..............-----....---•----.......----------.............................................................................. .O Description of Soil...................••-•-•-------------------------------•----------------------------------------==-----------------------------------------------------............---- x U ----------•---•-•-------------------------------------------•--.....-•••---•----...------------•----......------------------------------------••----.._...-••-------------...---....•----------- x ---------•-•----------------------•------•------------ -------------•----------------..............----•--•---•---------•-- --- ---•-------------------------- . ...... ---- U Nature of Repairs o Alterations—A wer hen a licab �... _ __ :._.. �_; f/ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y the boar of health. ned---- --•---i----•-- -- --------• --- Application Approved By.....'..... f' -- ------� -=--•-• - • .-•�' -- •----... .... �-nxe--- -- Application Disapproved for the following reasons:... ----------------------•--... ---.......--------------------------------------------........._ 1• ---•-•-----------------------•-----•-•--..........-•---...----------------•---•--••-----------------•-•----------------------•------...-----------------------------•-•--------•---•---------......--••- Date Permit No............................................. Issued._.-//..1 -- ............ Date od No - 1 ---- Fps....... .. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OE HE T h4�Yj............OF.............. . ...Q.......! .... .. ............................... Appliration for Disposal Works Tontrurtion frrinit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ... l •.�v✓ww S !J ry n - 4� ------------------------------- Locatlo -Addrgss ... /y\}- _ ` oN . ..!............... .. ....&. .. F - .-.._.' .................. ................................................v✓ � ...` � ` [� ner, a. Address Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type T e of Building No. of persons............................ Showers 0.1 yP g ---------------------------- P � ( ) — Cafeteria ( ) da 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 ( ) a Percolation Test Results Performed by.......................................................................... Date................ ... Test Pit No. 1...........:....minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Test Pit No. 2..............._minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•------•----------------------------•--•-•••---•-•-•--------------•............----------•-............................................... ---------- - "' 0 Description of Soil.....................................................................................-----------------•----•------------------•------------............---------------- x U -----------------••-•--•--•---•--•••-••---------------------•----•-----------------•.............._.....------••--•-•-------•--•----•--------•••-•---•-----•---------------------•...---•--•-- x ----•-----------------------•--------------••-•----•---••--•---------------•----••••-•-•--••-----------•--------•--••••-••••- U Nature of Repairs o �Alterations—A/ 'wer hen a licab _�"---49 -__-___��__..�Y'Z� ........ ------------------------ f F r�i:� ... -------- ------- ---... .-•--•---- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance'with the provisions of TIT1,;,:. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y the boar of health. Sined ......................... ' �.. % Date Application Approved By----- =fidit ._.. L-----'../ d -�, •. �d Date Application Disapproved for the following reasons---------------------------------•---------------•---•---------•-------------•---------------------._.......--•-- -------•-----------•-----------------•-••-•----••--------••-....-••---•-•----------•---•--...------•.....----•--------------•-•-•-•---•-------•----••-•-----•----•----•-•-•-•----•-----•-•-----•-•---•-- Date ,r PermitNo........................................................ Issued...-----------•--•••••---•.--•-Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .1.......OF.......... ` ' f Quprtifiratr of Tontpitattrr TH /IS TO C RTIF 1, That the Individual Sewage Disposal System constructed ( . ) or Repaired ( ) by....... . ..........'_. . - t R :. --- . --- -----*Zd at. �.. .......... ..... t. Ins . -�1!:/'x'f±!il... 91!_.l -.. _has been installed in accordance with the prions of TI" 5 f The State Sanitary Code as desin the PP P application for Disposal Works Construction Permit No " � s ..... ---- -------------- dated--------�------....�..._..._...---•------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTE WIL FU CTION SATISFACTORY. q DATE../..(. Inspectorip ........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTIV .4.............. No.......... 1 1_ " FEE..... _.... �,. .• t iJ[o Ft Ptirks Ton dltr$ion Vrrmit Permission is hVepair granted = -•- ------•- ................... to Constr t ( ) ( "an Individual S age s osal System .....W ' at No. -'s:g:''Y :f tiG .. ��"�----- t%J: h .. _.. _ ...... Street as shown on the application for Disposal Works Construction Per• 't No__ ______ ___________ ated.._.� _' �. '. :... � ----- -----•----------- ---- Board ofealth DATE......................................................................_.......... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS'