The URL can be used to link to this page

Home My WebLink About0070 ELM STREET - Health 70 Elm Street Hyannis ti A= 310-0190 r I TOWN OF BARNSTABLE VLOCATION �� SEWAGE# ®O��'T� -VILLAGE f�c�yi�/��/�r' ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.0 ,W SEPTIC TANK CAPACITY �X�✓`T�,�� I a a ��✓�° LEACHING FACILITY.(type) (size) 3X 3�X NO.OF BEDROOMS . OWNER PERMIT DATE: '5P --T—�f 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 NO � V.0 b J O � 0 1. SC T6 I TOWN OF BARNSTABLE LOCATIONS .S1:. SEWAGE # 9y—,S7—V-7 VILLAGE ASSESSOR'S MAP & LOT 3/0-- l INSTALLER'S NAME & PHONE NO. ` G �-E'7�I ' 9�-M4 SEPTIC TANK CAPACITY A613 LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUffLIC)VXTER�—D BUILDER OR OWNER' j�Lf ,�L 'tJ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED:"Yes N �r cg� ` e �P a \ .� \� ' ' , , J f�No. ZIP /I Fee �/rJ►Q e7J/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migozal �&p!5tem Cow5truction VCrmtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System l eindividual Components Location Address or Lot No. 7Q Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ed'L�ep Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building 407l�.J= No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) o gpd Design flow provided �� gpd Plan Date Number of sheets Revision Date Title Size of Septic TankX�J /b /'poa ode Type of S.A.S. Description of Soil 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 Bo f Health. Signed Date P oZ Application Approved by Date Application Disapproved by: Date for the following reasons Permit No.200 — Z5 C Date Issued. 7 2-oll No. Fee THE COMMONWEALTH OF MASSACHUSETTS _ Entered in computer: V,0,0 Yes 'PUBLIC HEALTH DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS 0(pprication for nigpogar dip-qtemCougtruction Permit Application for a,Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Iw I Individual Components Location Address or Lot No. ;�PP GCL �T 04V, Owner's Name,Address,and Tel.No. O Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �% L��odli�`..r��jic ✓�. �ld'Lip �nl�gC,Po•✓�s �'.�3 �i�7 Type of Building: _ Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building 47 No.of Persons Showers( ) Cafeteria( ) Other Fixtures I Design Flow(min.required) I, ; gpd Design flow provided �/ gpd Plan Date 6 � Number of sheets I Revision Date Title Size of Septic Tank �`XIJ'T�/j^ /000 6,d1 Type of S.A.S. Description of Soil 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 Bo f Health. Signed Date -Z Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 200 - 2 5 G Date Issued Z 2d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO C`E-R�TIIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V) Upgraded ( ) Abandoned( )by r o .4-L at ) w J`� /y�. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ?-49 j( - 2- -( dated R Z ZO 1 ( Installer CSC `��0�y/�^ Designer •0-4!/-'10 !8 Jji^i/J'O�✓. ,/�-P #bedrooms 14-1 Approved design flow q L4 o gpd The issuance of this permit$hall yot e construed as a guarantee that the system ill functto s' ed. Date //�r/�// Inspector I No7. :l-! ( ( ��?iCJ T JFee, ! t✓ r. THE COMMONWEALTH.OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS 'Wi5po5al 6p5tem Con5truction Permit Permission is hereby granted to Construct ( ) Repair ( � Upgrade ( ) Abandon ( ) System located at >92 -Z-Z/v tP7- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this germ'. Date g 2 r �O l 1 Approved by , Town of Barnstable Regulatory Services Thomas F.Geiler,Director KAM Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,NIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: a—lam Sewage Permit#��I'L�r'� Assessor's M /Parcel 's a p 3/0—/moo Installer&Designer Certification Form Designer: -2>4wo Installer: Address: d kiL�1.d1_)1C_1Y Address: ,//�`�_ On �� j J �' �s issued a permit to install a (date) (installer) septic system at_ ?C ObM C YOV Lbased on a design drawn by (address) < �4UI1� '"/'7t.�.�f e<S dated (designer) �Icc ify 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. Stripout (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 ofthe septic system)but in accordance with State& Local u--' '-+ions. Plan revision or certified as-built by designer to follow. Stripout(if rP- -meted and the soils were found satisfactory. OF DAVID 9ny 8. � z nstaller's a MASON �j 9 No.1 o66_o Co IST 9 (Desia er's Signature) PLEASE RETURN TO BARNSTABLE PU J _.,yfE OF CO", HAIL;CE WILL NOT BE ISSUED UN L ti, nu L to L mb FORM AND AS BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DMSION. THANK YOU. qAo fice fonns,&signemenificauon form.dw o Town of Barnstable P# 3L Department of Regulatory Services Public Health Division DateMAM 1 J � ie3q. �� 200 Main Street,Hyannis MA 02601 gFD Date Scheduled l / Time FeePd.� �Soil Suitability Assessment for S wage Disposal PerfortnedBy:7/•`t'V� Witnessed By: LOCATION&GENERAL INFORMATION Location Address--�,y�(J n4p A,v` Owner's Name b Address Assessor's Map/Parcel: I / �9 Engineer's NEW CONSTRUCTION REPAIR Telephone# 67� Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) W Parent material(geologic) — ' � '- Depth to Bedrock Depth to Groundwater:Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater�` Yam►. 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 ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST_ Date Time Observation Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ O Time(9"-6") End Pre-soak Rate MmAnch l4 I 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:\SEPTIC\PERCFORM.DOC 1f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) ottling (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) DEEP OBSERVATION HOLE LOG Hole# --_ _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven DEEP OBSERVATION HOLE LOG_ Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven Flood Insurance Rate May: Above 500 year flood boundary No des Within 500 year boundary No v/ s Within 100 year flood boundary No 11es Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious a e 1 exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of na y occurring pervi us material? Certification I certify that on /0 (date)I have passed the soil evaluator examination approved by the Department of Envir entaI Protection and that the above analysis was perfo d by consistent with the required training,expertis d e erie ce d cribed in 310 CMR I'.017. Sig. a Date Z �O / Q:\SEPTIC\PERCFORM.DOC - -- __ - ASSESSORS MAP : TEST HOLE LOGS � 5 _ -._ . _ PARCEL: 190 NOTES: -- FLOOD ZONE: �C/p✓ � G/ �i SOIL EVALUATOR : - - - w -_e __ _._ ._ _ WITNESS : W AL 5 � 1) The installation shall comply with Title V and Town of Barnstable Board of REFERENCE: // q DATE: Z 4 Health Regulations. alb 4_ /..__.._. __cs ! __� ✓_ / PERCOL TJ ON RATE:„� ��,.�. 'I � 2) The installer shall verify the location of utilities;sewer inverts and septic �<} / p � f G ✓ components prior to installation and setting base elevations. _ ` 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first - - - two feet out of the d-box to the leaching shall be level. fll� C- WAD p 4) This plan is not to be utilized for property line determination nor any other 1p �,k (� purpose other than the proposed system installation. 42 �� c5yw(n 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H 10 septic components. 1� ) property Yproperty property LOCATION M A P L ,I, 7 Theis bounded bcorners andlines. 8) The property owner shall review design considerations to approve of total �� "�✓ ID I V 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 h J y approval of the design flow by the owner. 4 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall Yvij be removed along with contaminated soil and replaced with clean sand per Title V specs. 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service line. The line is to be sleeved as aforementioned and maintained in place. FLOW ESTIMATE `' 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. BEDROOMS AT �o AL/DAY/BEDROOM - GAL/DAY 12)The installer is to take caution in excavation around the gas line if such exists. I?�GJLJGJJ 13)The installer shall verify the location,quantity and elevation of the sewer lines exiting the dwelling prior to the installation. 440GAL/DAY x 2 DAYS - d7 PGAL —-- USE 10DO GALLON SEPTIC TANK - ��w�u2. Via% t° M14, I SOIL ABSP'fTON 'STEM_...--- _._.____- -- ,o {- U6 �x, 8 ✓L►2G u i o � AREA:SIDE ARE c3Z �-t v� ' ?( ? �N OFtijq�S�, DAVID BOTTOh Af,ED, � a MA nor o /E ✓ il I !-r EPT I C SYSTEM SECT I ON "��, 41—w- D t 9)IM t 14 (0 taw / 4 51 1 J, Li FiCrOl GALTT SEPTIC TANK 4 - - - - iis. • -�.,,� ,��.,. . ;�, iTr..,�fi�,yS'prx yq ,+�ybT _� - - I ��. — 1 IV V� � �- SITE AND SEWAGE PLAN LOCATION : 0 .1. PREPARED FOR : -:I i C, M i CALE: DAVID B . MASON �6 DATE: I Z DBC ENVIRONME0AL DESIGNS EAST SANDWICH . MA 3 ) $33- 2 i 77 DATE HEALTH AGENT ( 50$ W z I i i