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Home My WebLink About0018 GENERAL PATTON DRIVE - Health , 18 General Patton Dr 292-106 Hyannis I I, I 4 y Town.of B In JUM, Depar0no at ofRogwatoAy.Services AWSIOU 200 MAln 5ireet,Hyannis IAA.02601 mw� Date Scheduled Fee�"�A, 1pm 0. do Soil Sufthility Assess ent fo ° Performed By: ►� ( Goy Su V e 1 Witnessed Y. Location Addrep 0 G-e-ne-, Owner'sNanxe ��i/B✓1� 1 a.A Address r 4 Assessor's Map/Parcel: b?9o1/�D�! nginccr'S 1'Iatno �0 w e 1►Ab. NEW CONSTRUCMON REPAIR Telephone0 (SD F, 3 b a - �xxv Land Use: wOGd e sloprs(9b) 57 Suriaac S.toues ��(�/� - Distance's flom: open Water B ody it Passible Wet Alen fk Drixxldng Water Wcll ft Draihago Way > ft .Property Line >/0 ft Other ft SIC TlCM(stmet name,dimensions of lot,exact locations of test holes&Parr tests;locate wetlands pxoxixniiy to bolos) Ls MM 4p N Parent material(geologic) L a WI De th tv l udrgcl �Q P 5 Depth•toGmundwater: StandingWaterinHolo:_N � _ Waepingl'1'atztPltPpac �J Estimated Seasonal High Groundwater_ Mothod Used.• �✓ Depth Observed standing in obs.hole: __In, :DaptJxo-s-it Qgglq; ltt, Depth to weeping from side ofobs,hole: ChouadwnterAdjuetmank fz. Index Well# Rrading DAte: Index Well 1pYal � Ac((.f t kbr, _ Adj.,qro4zdwatex Lavul— PERCOLATION TEST Obsorvatloxt Hole## _ L/� �lxne•at.�" ,.� _, _. Depth of Parr. t!/ ` Time At G" Starr;Pre-sank Time @ Time(9"-611) and Pre-Soak RateMinjluah "G�1,��•a�� Addldonal?estit±�Needed(Y_N)5itp aultabilily,MSaessrLient:-,3iCe,'rE155Grt' Si tf:,;'•alioM: - - original: Public Health Dlvisloa Observation Holq Data To Be Completed ou Bark----------- ' _ f **'t jf percolatio' u test is to be condaactod witbloat 100' of wet ud,you must first-aota�'the. Jul rBstable +Consqvl ton Division at least one(1)'week prior to beginning. Q_18M`rIC\P)9RCP6R1V.I'DOC DFEF,OBSB1MXTr, 0X'-A0Uq LOG Depthfrom Sall.Hariznn Soil.Texture SdIl Color poll•. 0t'hcr Surface(in.) (UnA) ,(MnnseIl) Mottling (Stmaturc, Stoned;Boulders, o i`Con ey,Wca aval) 1 a%/R s4 DFr,,q]P40B8RRMN A. n0 ME 0EV,L0,G Role� Z Depthfrom Sall Horizon S (Texture Sall Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Scones,Boulders. onsis cn Ya Grave a -g/ S l c)YR 3/Z DEEP 01BSE V.MON ROLE L 0 G Depth from SoilSarizon Soil Texture Sail Color Soil Othcr' Surface(in.) (USDA) (Mansell) Mottling (StructuXo,Atones,boulders. Ce i to c Gravel) I DEEP ORSERW-TIONROVE LOG Depth from Soil horizon SoilTaxturc Soll Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones~Boulders, Co si tan 6 '1.aar�7sa�l•ancia�.at:e'1Vx».ts:. / •, Above 500.year flood boundary NO Yes .✓__. 'Within 900 yearboundnry. NO + Yes Within Lao year flood boundary No•�.. D�¢Y�of�a�EtrxaYY��ccx�r�in�:�erwxa�ls 1�Iataril�� • Does at least;four Feet of naturally occurring pervi Usnalarial e7cist zn all areas nbs6r,ved throughout rho area proposed fbr the,soil.absotption syetem7 -Y- 7 If not,what is the depth of-naturally occurring pervious matar1a11 - - �erti9�xcatiam x certify that on. �/� Z (date)r have,passed the soil evaluator c�camination approved by the Dopaitmant of En'virOTIMMItal Protectlon and thatthr, above analysis Was perfoxzned by me consistent With . 'the rcquired training,expertise and experience described In�10 CUR 15.017. Signature '�� — "--r_ Datb lq l�� ' Q,.�,�IYT'IC11'L�IZ.CPOTYI!(,DOC • TOWNq BARNSTABLE II LOCATI ON l SEWAGE # VILLAGE ASSESSOR'S MAP & LOTS INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) n L NO..OF BEDROOMS WELDER OR OWNFR ^_ � PERMITDATE: 3 (� COMPLIANCE DATE: �7 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 1 V 1 O I (itspol ice TO F BARNS'7 TABLE I f LOCATION > SEWAGE # VILLAGE �� ASSESSOR'S MAP &LOT - 16,6 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY CAL- LEACHING FACILITY: (type) Tic (size) NO.OF BEDROOMS BUILDER OR OWNS PERMITDATE: � (-2 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 � `:�C 1 ( � � 11 1� 1P �� ' V�� ( � . • -� ® �- G ,;, �' �' l� -� No.- •--- . .....�120_ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Application for Bispnial Works Corm rnrtion famit . Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: --....1 ---------- 1------ � -�` ]....---cam • .----------------•-------•----•----------- Location-Address or No .....................!aCl ,I G 1?--Y �_j ----- .................... W ........... Ownerf 0 G� p Address� �� Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................... _Expansion Attic ( ) Garbage Grinder ( ) �+ 4 Other—T e of Building No. of persons............................ Showers — Cafeteria Ga 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. 3 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........................ (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W' .............................................................. ........................................................................................ 0 Description of Soil........................................................................................................................................................................ U Nature of Repairs or Alteratio s—Ans er when applicable-10 ----- ......:5&)&..�.__i4._.._.`-Zxs� It�'Tl��r-•----leg - = ------------- ' E....1000..•-••••-••!�-----. .... S-'�OA/t3 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system ' e a til a Certificate of Compliance has been issued the board of health. Signed.......... ------...-- 9 ApplicationApproved By ----- ----- - ---------------4�.... . .. ... -------- -- . --- --- .................-- ---------- .................. Date Application Disapproved for the following reaso - ------------------------------------------------------------------------------------- -------- ----------------- ---- ----------- - .. ... -------------------------------------------------------------------------------------------- -------------- ---- --------------- . - Date Permit No. j —1---------------- ----- Issued --- --------------- s. tip No---- - -------.... Fxs...... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works Tonstrur#iun 1krutif Application is hereby'made for a Permit to Construct'( ) or Repair (, an Individual Sewage Disposal System at: • I fa -- dry er Q�RZ'tovl - ' 'v�. H 4t�'N -•• -•--• .....--- _ - --------------------•-----•--•-----................ Location-Address or Lot No. '` owner d�V Address IGb s-etx�t 4_,e�f...., rfi did ti`' � a .............. ............................ ..................... --------- -------------------•--....------•---------•------•.---------------------------•------ Installer x. Address" ° UType Of)Building Size Lot......----------------------Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 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. l................minutes per inch Depth of Test Pit.................... Depth to ground water--------.--.-----.- -.. (i, Test Pit No. 2................minutes per inch Depth of Test Pit......?K........... Depth to ground water.........--.........---. 0+ ...............................................................•.............................-......---............................................-........ 0 Description of Soil----------------------------------------------------------------------•------------------------------------ ................................•......•------------- x 1 (� ................................................-.........................................-.............................................•............................................................... W tx -----•-••--•-------------------------••--•-•----------••--••----------•----•--•-----•--.....--------------------•--•-•----•----------•--•••-----------------...-••-------•••............................ ! U Nature of Repairs or Alteratio s—Answer when applicable....Q ' ...... ------ :��..�...tt�-...... � �a - n.SY{''L�— t00a. S:." --......... f.�0 0. t.`_� 5`�ON LT Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system ope ao till a Certificate of Compliance has been issued by the board of health. Signed ......... ------- - -�-- -- --- ....q--------------------- ----3 /--21 " ,/ Date Application Approved B ------ -............-.. PP Pp Y ..� IJate Application Disapproved for the following reaso . -----..---------------------------------------- -- ........ ..............................--------- -............. ---------- -- -- I... .... .'................... ------ ---------------...------------------------------------------------.- ........................... ---------- P .-... ( 'G.. J.... .......- Issued Mte .. Date ;Q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE k6er#tftra e of 10-1,IImytiance THIS IS TO CERTIFY, That the nnd,' idual Sewa a Dis sal System constructed ( ) or Repaired (�J ) Y ------------------------ Installer at ........:b------------------C.Zr'E' J'�' PisQQ l. -------0.�SfA....--- ------.1!t4.h-Af1��......------------.....------------..........-----...---- has been installed in accordance with the provisions of TITLE 5 f The Sta a Environmental Code as described in the application for Disposal Works Construction Permit No. ......-- --~- .��... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CO_NST LIED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------------------------------- Inspector ...........................................................------------------------------------- 0L THE COMMONWEALTH OF MASSACHUSETTS' BOARD OF HEALTH No. FEE.......... ...-- 3 TOWN OF BARNSTABLE .. ` . t.--••-••.............. -..... Disposal Works Tuns#.rur#inn r uttt Permission is hereby granted...._`... �`'^"' '� A� to Construct ( ) or Repair (V) an Individual Sewage Disposal System ..... Street � as shown on the applicationtfor Disposal Works Construction P No.l� .r__.... . t.d..... n�?._r�....__ G... Jy - - -- ... �r ,cam DATE. .... ( .7....................................• Board ofeatth FORM 3850E HOBBS at WARREN.INC..PUBLISHERS v