Loading...
HomeMy WebLinkAbout0020 GOOSE POINT ROAD - Health 20 GOOSE.POINT RD:, HYANNIS A=252:086 o ` ------------ e e o i o � 0 � o o r i � o j � o Town of Barnstable P il �pFIKE Tp IL4e Department of Regulatory Services BARNSTABLE, Public Health Division Date_ MASS. ` v� 1639. �0� 200 Main Street,Hyannis MA 02601 A�f0 MAt 0 Date Scheduled- �° Time tM Fee Pd. oor w Soil Suitability Assessment for Sewage osal Performed By: t 1f 2 ��� \ � Witnessed By: i � fin-, n , r LOCATION & GENERAL INFORMATION _ Location Address -Z0 Pa,r.f T?4 Owner's Name:Jq-ales 4 (AAA:$ Address C,�il Csl/��L2 �1� 32 r l Vf �? �q Assessor's Map/Parcel: 'Z e-—Og� Engineer's Name NEW CONSTRUCTION REPAIR X Telephone# ,jd-737-47" '"Land.UseS t( ' 1\ orI Slopes(%) — Z Surface Stones �Qil.e Distances from: Open Water Body ?3C:10 ft Possible Wet Area ao ft Drinking Water Weller lJ'G d Drainage Way�fl Property Line � ft Other— ft [SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) 71_16nq'jI 7f 5pi_ ?r •� a ®Z . V� Parent material(geologic) VN �� qq Depth to Bedrock—Al"_ Depth to Groundwater: Standing Water in Hole: /NO t-c / Weeping from Pit Face Estimated Seasonal High Groundwater 2 ( L (/Lc! 7 DETERMINATION FOR SEASONAL HIGH WATER TABLE I Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: Depth to weeping from side ofobs.hole: in. Groundwater Adjustment 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 Cn Time(9"-G') _ r n 6 ,p,t• „1 End Pre-soak Rate Min./Inch �Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) 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 fi¢-st notify the Barnstable Conservation Division at least one(1) week prior to beginning.:" Q:\SEPTIC\PERCFORM.DOC 40 I� ie DEEP.OBSERVATION HOLE LOG Hole#'T_�'—N Depth from Soil Horizon Soil Texture .Sdil Color Soil• Other S'.Lrface(in.) (USDA) (Munsell) Mottling '(Structure.-Stones;Boulders., Consisteag,4,0 avoll DEEP OBSERVATION HOLE LOG Hole#T�'=Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ consistency.%Gravel) t2'P 2 DEEP OBSERVATION HOLE LOG Hole#_ pth 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. _ ggsiste fly.96 Oravel), I i Flood Insurance Rate Mau: Above 500 year flood boundary No— Yes • V 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 pervious material exist in all areas observed throughout the atlea proposed for the soil absorption system? `� S If not,what.is the depth of.naturally occurring pervious material? — C.ertification -. I certify that on 40ACk (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 ' 'ng,expertise and experience described in 310 CMR 15.017. Signature Date Q:\S.EPTIC\PERCFORM.DOC Is TOWN OF B STABLE r � LOCATIONy% SEWAGE # VILLAGE y�g^�-� ' , ASSESSOR'S MAP & LOT ,1 S2- 094 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) ,Z2 Sk `2 NO. OF BEDROOMS 3 , BUILDER OR OWNER PERMIT DATE: eZ—�a q y COMPLIANCE DATE: 7 - 10 - ZA 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 L Furnished by �a .f W J � h A. No. gy—7 Fee ve THE COMMONIN'E TH OF MASSACHUSETTS Entered in computer: + Yes ` 'PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 1 t 01pplication for �Digpozar *p$tem ConeuU* rtion Permit Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No., /��///�J /-mil/ Oer's Name,Address and Tel.No. oZd�O�SR�f.✓i ^ Gam[ "�SINN/ 1 �J AM F'.�Jl��t//•��7!-s' /� ; Assessor's Map/Parcel 26 G-ooSQr'j, ��I' Installer's Name,Address,and Tel.No.' Designer's Name,Address and Tel.No. I�2G/fr- Cow ST �77.5' • :36z Type of Building: Dwelling No.of Bedrooms :3 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 Nature of Repairs or Alterations(Answer when applicable)_ eta's 4Z r/.0 w 7o /do o S?' 3 /"?.4 K 5�ST 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 is' d by thi and of Sign�d� Date Application Approved by Date e Application Disapproved for the following reasons Permit No. Date Issued 7 _ TOWN OF BAPSTABLE LOCATION-0 G�s c f61.�7- SEWAGE # 5 7— 11.7 VILLAGE y'9 ASSESSOR'S MAP & LOT Q&_. INSTALLER'S NAME&PHONE NO. D -2 SEPTIC TANK CAPACITY l ©0 6 6—,a C X f S 7- LEACHING FACELITY: (type) (size) NO.OF BEDROOMS 3 rt/ �/'y/l F✓ 7�i N //✓ BUII.DER OR OWNER PERMITDATE: �Z—1, "�� COMPLIANCE DATE: '7 , 10 - 2'h Separation Distance Between the: j 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 13�� �pD - 3u . C � r P3.�' 3 /'1 Axe /'1 iae,zs' i`:S, .....,�.. y ..w..-....•i,yar ,._.w-,_. •,. H. ,•.-,- � .. n,r .�r ,,,.:, �.-aar r+•f:`r,'-:."�arsv*+TMi=.rt +•-+.,.irt- =`rv�S�ji•7dPw^Y "_ r V No. Fee THE COMMONVII£A'L ITbF MASSACHUSETTS Entered in computer: Yesg PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Zigonl *pgtem Construction Vermit Application for a Permit to Construct( )Repair Grade( )Abandon( ) El Complete System 'O Individual Components Location Address or Lot No.. Owner's Nampe� Address and Tel:No. 0�0�pos� /o� ✓7- �� 1_V41We.W✓. f -�h t:Jv•t/�T �•✓S Assessor's Map/Parcel 2 d 6-o oS 07 rear ; �" a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 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 1..gallons. Plan Date Number of sheets s Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) fAAP /yIAK A, aid./i2AroQJ12 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 iss by this card of afth. Sign:: `� Date Application Approved by E' - or. Date — — Application Disapproved for the following reasons ° Permit No, Date Issued_ 7 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 (Z ef at 0, G'oo S6 11,p r a- r r? has been constructed in acccor ance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 7—i ' / + ( Installer Designer t The issuance of this permit shall not be construed as a guarantee that the system will function as designed. � Date '7 C . v( n Inspector f -•No. /0 —`// •——.—.——•——--———---—•---——--— Fee THE COMMONWEALTH OF MASSACHUSETTS '° . , PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi!gpogar *p!9tem.Congtruction Permit K Permission is herebyranted to Construct g ( )Repair(Upgrade( Abandon( ) System located at 2 o 6 06 SF �6 ,w." 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 this pe it. G Date: Approved by ' _ lie- i ;44 10/9/97 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 ENGINEERED PLANS) i I,/,Ay"f AA"h a d=.a L4ereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at Goo5d'-2e meets all of the following criteria: • There are no wetlands located within 100 feet of the proposed leaching facility • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will gpJ be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: ���s- A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) B)Observed Groundwater Table Elevation(according to Health Division well map) 3 SIGNE DATE: 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]. q:health folder:cert 1, f l