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HomeMy WebLinkAbout0950 FALMOUTH ROAD/RTE 28 - Health 950 Falmouth Road Hyannis = 250-031 TOWN OF BARNSTABLE �! LOCATION JS(.) �Nl rh a�t h A OCA J_. SEWAGE#6J Y. 7 6® F= V"ILLAGE �yC.ng;S ASSESSOR'S MAP&PARCEL as�/31 INSTALLER'S NAME&PHONE NO. 3PEAK1ncn f*Z-gat,-S S06 IM-S,rGS' SEPTIC TANK CAPACITY 0 ' LEACHING FACILITY: (type) y Tn F'ltAaraA S 305c))(size) 3G,5-X 1),/6 NO. OF BEDROOMS J OWNER 81?nN StRffi F, «o45�,%c 094tko2rty PERMIT DATE:16-15-dOl 9 COMPLIANCE DATE: l'021- L-)l Y Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N 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 ©Ong:,iL rdi,V v vW a � � o - 0 0 o � � D L60 LOT{NO. ADDRESS _9,6 � � OlvNERS NAME: SEWAGE PERMIT NO. : NEW: REPAIR: .,/ DATE ISSUED:_/ — 7 DATE - INSTALLED: i NSTALLERS NAME : T INSTALLATIO►1t OF: (5 06 3 Lse(p k ( (Y WATER TABLE: FINAL 'LIT I�BY � DRAWING OF INSTALLATION ON REVERSE SIDE: Cr a � �1 �0 V r �i T' 4w N �� TOWN OF BARNSTABLE LOCATION `D SO Fq k o Ice. SEWAGE # • VILLAGE 14M AJN o s- ASSESSOR'S MAP LOT INSTALLER'S NAME & PHONE NO. UA)KlV0 Jnl SEPTIC TANK CAPACITY y m k N ow.n.1 LEACHING FACILITY:(type) (size_) NO. bF BEDROOMS PRIVATE WELL OR PUBLIC WATERj� OR OWNER a&xm ri c%,b'ie Ilolllp,vC, 4vT DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No O � � _ _ t�� \ + 'L � � � � � � a rr J Town of Barnstable P# v Department of Regulatory Services D /A . BAMMBIX Public Health Division Dace P �a7q. jai' 200 Main Street,Hyannis MA 02601 �,�tb r�a�° ✓ Date Scheduled Time Fee Pd._I Q Soil Suitability As essment for S: 'p a Performed By: Witnessed By.LOCATION:&GENERAL INFORMATION Location Addres�s Owner's Nam P ' I- �f�'iUS/ lo Address //G '56 Syz ee,-�-ten • Assessor's Map/Parcel:o,2 SV / Engineer's Name'08n-0 NEW CONSTRUCTION REPAIR l" Telephone 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 Itlands in proximity to holes) � I I Ca Zz. 133 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 • - Observations �I Hole# X III Time at 9" An Depth of Pere Time at 6" Start Pre-soak Time @i Time(9"-6") End Pre-soakRate Min./Inch /' \ Site Suitability Assessment:,Site Passed Site Failed: Additional Testing Needed(YN) ,7\ 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 - • Y �1 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 o r. o 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 Sod Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Man: / Above 500 year Flood boundary No— YesY/ Within 500 year boundary No ' Yes_ Within 100 year flood boundary No Yes - Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe io terial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of n urally occurring pe ous material? Certification I certify that on ® -` (date)1 have passed the soil evaluator examination approved by the Department of Enviro en Protection and that the above analysis was perf rmed y me cons tent with the re ui raining,experti � ex �nde cribed in 310 CMR 15.0I17. Signatur Date 4� �� v®'� r Q:\SEPTIC\PERCFORM.DOC r " No. ��— �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliCAtion for Dispos4l 6p!"t' construction Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. q 50 5a%mnvkh U Owners Name,Address,and Tel.No. 1Avo-+�n'5Mq nkc,bjmA. c�USrY1 A��McrikY Assessor's Map/Parcel arj0 PoxcL1 0 3 (AMR a O installe O,s Name,Address,and Tel.C ObJOk>n Designer's Name,Address,and Tel No 1' S pe��irnc. 1N+A ° �,� Spedy 1 OLY1 SS`SPCA 1 - _ / - TypeofBuilding: S S"�'ja3'0'� Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Buildingt-SI( �h CQ_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 13342 gpd Design flow provided4 gpd Plan Date kb it 451114 Number of sheets �, Revision Date Titles Ssc.CX C,3M VY`)C V%0Y\ F0Y qS a 'Fdklw 4,•V\ Qd uCInAlI MA Size of Septic Tank Type of S.A.S. Description of Soil /jl� .-A'le. �1 A/18 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 Boar f Hea h. S'gned Date ®� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. CP-o qtb Date Issued 10 L) No. Fee 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE,I MASSACHUSETTS Yes 9pplication for Nsposd_1 ?pate dConsiruction Permit Application for a Permit to Construct Repair PP ( ) p ( ) Upgrade('� Abandon( ) ❑Complete System ❑Individual Components Locafion Address or Lot No. q 5 0 Fa t m w 1 h R d Owners Name,Address,and Tel.No. VA a r)n,s Vl ra � Assessor's Map/Parcel NA Instal_ler's Name,Address,and el.No. Designer's Name,Address,and Tel.No.' Y,\ x cc LL �' "" •� \ ,r. ` /`. ✓ r l :1 C� �L�� Sc+ �w� t, 1 �°� ( 8 < ktl4 h3.�LY+ iY� Type of Building: S-t0 3 � -2,h ' ?� Dwelling. No.of Bedrooms '_� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3p gpd Design flow provided �,/(� gpd Plan Date ` () /1 / }`, Number of sheets .1 Revision Date TitleC ; ���� p f� '��s�to f )>\�\ �r 4, >v� �o; qti �n� t Y y n1 U, LnV)Vl�: till\ � �.. . . Size of Septic Tank Type of S.A.S. Description of Soil Aj r Nature of Repairs or Alterations(Answer when applicable) r� C__�/a,QeE l..4C.4,- ',R-rS 7L-/-i Date last inspected: fay, i Agreements he undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordZ with the provisions of Title 5 of the Environmental Code and not"to place the system in operation until a Certificate of Y Compliance has Aen issued by this Boar of eal h. S• ed Date Application Aoprovedby Date Application Dis)pp oved by Date for the following reasons Permit o. Date Issued.. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at �� � ► �.) �nibj has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoQUI/_QCQated /© Installer ,fin o.0 Designer #bedrooms Approved design flow � ,� gpd The issuance of this permit shall notbe construed as a guarantee that the system will f/unction,s`designed. Date i j .1 ! L) Inspector No. ; I L_l GG' Fee ,{b c) THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction Permit Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at 0, \,5 0 , a Gk y1 !��\':�, 1�� J 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:Construction must be completed within three years of the date of this perm(i� Date �� r} Approved b ` f PP Y Town of Barnstable P,,oft"E ratio Regulatory Services Thomas F. Geller, Director ' BAMSTAEU6Public Health Division 059.9 MASS. �, ATBD MA'S a Thomas McKean,Director ' 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: h`� Sewage Permit# �� Assessor's Map\Parcel ck (D . Designer: rR pl &MCAtl'��(`+ �0'�S�'��"� Installer; �i�IP 0��►'Y�(1K� �X CCW_01 �1�`q Ll-e- IJO�v2 Address: IS S S:aL \NCO-4 Address: On 'Lg r , an C'Q&r 4Ufwas issued a permit to install a (date) (installer) septic system at 5O �ckIm� p�� G11t�`s.�-based on.a design drawn by (address) 0. 1, `n C onst`w dated o 1 D (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include�mmor 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.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. OF o DAVID �y MASON 1 (In st s Signature) NO, ,0 /STS?� . . .. esi s Signature) (Affix Designer's Stamp 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:Heilth/Septic/Designer Certification Form 3-26-04.doc ��:a as..,�y�� Ili p, -�,"�i r �,�' �` '�'; '� =�r: ~;, - - h _._. �.t,., - r- f Town of Barnstable Regulatory Services Richard V. Scati,Interim Director MAW ``� .Public Health Division � Thomas McKean, Director. 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property Address: O64LA00-1fl 00 A Hil V"Q. Assessor's Map\Parcel: Property Owners Name: v�l In accordance'with Massachusetts DEP alternative system approval letters, the following c ification information is required by the Owner of record. : The :Owner of record'must place an "x in the applicable box next to each line certifying the information. Yes ❑ I have been provided a copy of the Title 5 i/A technology Approval letters. 15 page Standard Conditions letter and the specific technology letter) ❑ have been provided with the Owner's Manual ❑ Xor pave been rovided with the O eration and Maintenance Manual P Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice,as required by 310 CMR 15.287(10) d the Approval ❑ For Systems installed;under a Remedial Use Approval, I agree to fulfill my responsibilities to. provide written notification of the Approval to any new Owner, as required by �10 CMR 15.287(5) ❑ I°l If the design does.not provide for the use of garbage grinders,the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA,if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR°15.303 . ..tidS74 / Etgree to comply with all terms and conditions above. ro Owners printed.name operty Owners Signature Date Note: This form must The :submitted alone with the septic system disposal works Permit application for all IAA systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design criteria. Q:\Septic\IA homeowner certification.doc R AsBuilt Page 1 of 1 LOT NO. . ADDRESS:,3170 -em Q'd i "�7//lf J S OWNERS NAIIE: ( ,4�✓L'S�sr,� rClj .._S__� v�� . SEWAGE PERMIT NO. :7/�/3 14EW: REFAIR: ,,� LATE ISSUED:_J- 747 DATE INSTALLED: !NSTALLERS NAME: C-. Q INSTALLATION OF: iS-64 `3Lk16 WO, WATER TABLE: FINAL INSP TION BY: JP DRAWING OF INSTALLATION ON REVERSE SIDE: � b � G X rc�C ` e4 cc: G Wit- 7u1;f tn.�-�vs P _ Ct r�l� http://issgl2/intranet./propdata/prebuilt.aspx?mappar=250031&seq=1 9/17/2014 No. 7— /3 k Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mtgoml 6potem Con.5tructton Permit Application for a Permit to Construct( )Repair(><Npgrade( )Abandon( ) ❑Complete System ❑Individual Components JA Loc } d ress o o No wner's Name,Address and Tel.No� Assessor's Map/Parcel Installer's; e,,4d_dressed,Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Natu�f Repairs or Alterations(Answer when pRli NO) 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-Till"of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issS<jy th' B and o H�th. cy p Signed y I ��•,:� Date /- / _ 7 Application Approved by Date r` T ` 7 Application Disapproved for the following reasons Permit No. l Date Issued R .a _` ,� i� r �i f: 1 e . �, >� � � a ,�. - , �:—� � �. 1 1 .( g: C z t t �r �....,r.., ,-,�M..� �` . . - _. :.. .. •.. .. » .. -tip::- . .. `+ -'� .,, ..1 7 - /3 No. F9 , Fee y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC.HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication fori� ogar,�pgtem Construction Permit 1 Application for a Permit to Construct( )Repair( Upgrade Abandon( ) ( ) O Complete System O Individual Components 'Location Address or Lot o. wner's Name,Address and Tel.No. 1WG�r i i %j calcrt.�� � 4e No. 415 f t-`� � 7 Assessor's Map/Parcel ` s Installer's Nine,jddres,a and ICI,No. Designer's Name,Address and Tel.No. 4. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder( ) Other Type of Building _. No. of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil a''t Nature Repairs or Alterations(Answer when pplic bl ) — oe 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 Certifi- cate of Compliance has been issi by thi B and o H h. q Signed Date / 7 Application Approved by Date �` �1. Application Disapproved for the following reasons -- Permit No. f 7 f Date Issued THE COMMONWEALTH OF MASSACHUSETTS ,_ BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( epaired ( )Upgraded( ) Abandoned( )by �,r at �� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 /-3 dated / Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date ! cf ­7 Inspector No. 7 I7j Fee S-6 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mtgozar *p5tem Construction Permit Permission is hereby granted to Construct( pair( )Up ade( ) bandon , System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of Zthi permit. Date: �— y ' 97 Approved by NOTICE:This Form is to be Used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, , hereby certify that the application for disposal works construction permit signed by me dated concerning the s�v property located at �� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED: � �— DATE: L L L LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. j xert t J / V ^V r•y rr)) i �l r, r liy�(] I� et 1 { d }i a •'�%Aj• sr t •r r r -U a" Yy• t. �• l c WU WAF ♦y i� c� ;cam .. � ,� 4•�•` 1 ii Ji �'1 r: �;',� I 'qmt t ml v I rE.•. ,i! °r$�iy; A rP s i3 rx !� '� t r {J �� "t I` .. �' S of `` .4t .{ l• i;. 'd sr{r .. s t" f �, + - ix. 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EST/MATE-0 FL W Gt1/TNESSED ' ' V C �- Q_ GAL./8R.IDAY x Bi2� - 0 T>AFR-F_ORN!EL> Or: 2)'V/,U.9, i R'EQ• SEPT/C TF-�Nl� CAPACITY: HOLE 1 /VIOL E ' Yl AGTIJAL SEPTIC TANK SIZE : l5 ., !-EAG/- 1"G 'A R E-A DER u'/ E TS q CoRr[ .�+f�f� CA+t�I/cSf� I + BOTTOM LtdLP y TOTAL LEACHING CA - ACIT`/� ,1 GAL. / ,2E SEP.-VE LEACH/NG CA ACITY 63p GAL.4µ1 WD. - ' !1 ALL 4AJORRMAAJS / D H P AN MATE R/AL S SHALL C o/l/FO R M 70 .E.P /T E / 1 fo ►� �I AND THE TOWAJ OF s � I 1 �2ULES HNO i2E UL G 147 FaT/ONS � "�° SUBSURFACE DISPOSAL OF ' / r - +.y r Qi SANITARY SEWAGE. /ViV 2) C OMPL/ANC E l.�//TH 20 / G R E G ULF-1T N IOS VD SHALL BE DETERMINED BY = /NSPECTai2 �CO/v!M/SS/O/VE�. - I 3) &� <JSTIIIlG AND FINAL GRADES SHALL z� REMAIN ESSENTIALLY THE SAME, - - 17—HE: �O }'770�c.! Off" ,q,[.�G UT/UT1t T E A PP/e o v E v /A,/V`S 4.TH;Mr/-/C B D. O F H E�q L_T H AGENT PL /`l of P CPO SE D OAST U -T/Old/ LocAT/o/V 1� s / T� /= L /q /V EF -REIVCE ; �# a1 ► S� 5ca e . 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