HomeMy WebLinkAbout0022 GROUSE LANE - Health 22 Grouse Lane
A= 16-004 .
li
i
I
i
TOWN OF BARNSTABLE
LOCATION ` (ICUJ ZA ,L�A,.�r�SEWAGE#_��JtQ
VILLAGE � ASSESSOR'S tMAP&PARCEL ���a L r
INSTALLER'S NAME&PHONE NO. l)O\."S
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) �A ` C=SiS4 Ssize /, 3 :��
NO.OF BEDROOMS�� L4 IS /0 er Jtcvo
OWNER A -,AA
PERMIT DATE: \ 0 COMPLIANCE DATE: Cl 0
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility IMFeet
Private Water Supply Well and Leaching Facility(If any wells exist on A //(
site or within 200 feet of leaching facility) l y �\ Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY ��/�
l�J
�►
cal
� b
t4
v . v
No. � Fee eV THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION — TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01ppYication for Oigoor &p.tem Cow5tructiou permit
Application for a Permit to Construct( ) Repair(,%� Upgrade( ) Abandon( ) U Complete System ❑Individual Components
Location Address or Lot No. �� ( c„gyp Owner's Name, dress,and Tel.No.
Assessor's Map/Parcel a�.
Installer's Name,Address,and Tel.No. esigner's Name,Address and Tel.No.
Sce
y irk
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Wo
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min..required) 3 gpd Design flow provided gpd
Plan Date �/�� /C) Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S. L4 A ► :C y /4 2.6 T QA3 k,,--)
Description of Soil $d C.'d cl-
J
Nature of Repairs or Alterations(Answer when applicable) �.
Gnc"
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 thi oard of Health -
'Signed Date ' / t
Application Approved by �n.. Date
Application Disapproved by: Date
for the following reasons
Permit No. 9010 —A ' Date Issued ( �
`7
No.. o� �— Z J6 f � Fee �d U
Entered computer:
_
~ Ed i
THE COMMONWEALTH OF-MASSACHUSETTS
s Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0(ppricatiou for 0t.5pogal 6p!5tem Congtructiott permit
Application for a Permit to Construct( ) Repair(d Upgrade( )" Abandon( ) U Complete System ❑Individual Components
Location Address or Lot No. d CJ el � � Owner's Name,Addresj,and Tel.No.
/
1
}
Assessor's Map/Parcel r a
Installer's Name,Address,and Tel.No. esigner's Name,Address and Tel.No.
IC
Type of Building:
Dwelling No.of Bedrooms Lot Size L Z sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 gpd Design flow provided gpd
Plan Date 5—r l j-'s— j/0 Number of sheets Revision Date
Title f
Size'of.Septic Tank '$0 , Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) e S 0
i
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 thi oard of Health.
Signed Date4. 6 0 ;
I ,
Application Approved by v� .S. Datet Al
Application Disapproved by: Date
for the following reasons
} ro
Permit No. ;G/u — 77 Date Issued ( ( o
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V) Upgraded ( )
Abandoned( )byK
at d Q5 C7R _Q k ` has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. .2 G a ' ,?� 7 dated C / /u
Installer Designer S.fit k V'W Q S G,C
#bedrooms Approved design flow gpd
The issuance f his pJnnit shall not be construed as a guarantee that the system mill t ction as "Signed. C
Date p
�� / Ins ector �/
-z
` No. .2.�/0 . ,�� . . .. . . . . . . ,., . . . ,-- .-. Fee /0aTHE COMMONWEALTH OF MASSACHUSETTS `
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
1=tfspogal 6p!gtem Cott truction permit
Permission is hereby granted to Construct ( ) Repair ( L Upgrade ( ) Abandon ( )
System located at 0 j A's- tG.l�lt�S
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 t e i .
Date C/ /I l; Approved by hf
�,+tr
Town of Barnstable P#T D
' Department of Regulatory Services
8MMSTA 14 : Public Health Division Date 1 (0
MASS.
200 Main Street,Hyannis MA 02601
rftl µp't A
Date Scheduled
Time Fee Pd. lod
Soil Suitability Assessment for Sewage pisposal
Performed By: 5 7z---P/-t6,xj .S r
Witnessed By: v V
J
Location Address
LOCATION& GENERAL INFORMATION
a 66
v%-Z_ ���� Owner's Name
Address
Assessor's Map/Parcel: Engineer's Name s �_ 1���5
NEW CONSTRUCTION REPAIR ✓ Telephone#
Land Use ' De-1 r-V/Y
Slopes Surface Stones N�
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ® ft
Drainage Way sb ft Property Line ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
�L
C-
`C
,
Parent material(geologic) 0V7'Ay`2AS H Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Pace VO Ai
Estimated Seasonal High Groundwater 4J /A
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: Ad
Depth Observed standing in obs.hole: in, Depth to soll mottles In,
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level— Adl.factor— Adj.Groundwater Level
PERCOLATION TEST bate Al Aar Thne A-
Observation
Hole#
Time at 9"
t
Depth of Perc ' _ Time at 6"
Start Pre-soak Time @ 'lime(9"•611)
End Pre-soak
Rate Min./Inch
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 first notify the
Barnstable Conservation Division at least one.(1) week prior to beginning.
Q:\SEPTI0PERCFORM.DOC
� a
DEEP.OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Sdil Color Soil Other
Surface(in.) (USDA) (Munselq Mottling (Structure,Stones;Boulders.
on i to rave
it
DEEP'OBSERVATION HOLE LOG Hole#7_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistencv.%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) (Munselq Mottling (Structure,Stones,Boulders.
Consistency,
Flood Insurance Rate Man.
Above 500 year flood boundary No Yes _
Within 500 year boundary No ®+/ Yes _
Within 100 year flood boundary No, l' Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurringmaterial?
Certification l
I certify that on /� �'�/ (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 training pertise and experience described in 3 10 CMR 15W,6 _25-
Signature • DateFlo
Q:\$EPTICkPERCFORM.DOC
Lassally
22 Grouse Lane
Hyannis, MA
BR Bath
KIT
BR
LR
BR
t
SEP 0 1 REC'D
LB-y
Town of Barnstable
OF THE Tp� '
Regulatory Services
BA Thomas• Thomas F�.Geiler,Director
9 '""SS. Public Health Division
nnA't°' Thomas McKean,Director
200.Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 101�1�1� Sewage Permit# ® Q—30Assessor's Map\Parcel — a(v ti
Designer: ! 'MP E{&,�i J�. 1-1��5,PE Installer: ,V-cg'r- ►A. F _A,t._)1L_
EAG L.E SvR-v
Address: qZ3 Zn vm A Address: 115 C l_b
Y�R�-c av�+Rs tti, M�4 y�-7j H YM.)k_)i s, P4 A. 6240 1
On /N-�1L- was issued a permit to install a
date) (installer)
septic system at 0 U S-'t' Lam, \Ayo�m;sbased on a design drawn by
(address)
E PF+� A. i4AA%, }PE dated
(designer)
I certify 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.
I certify that the septic stem referenced
P Y above was installed with mayor 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. �n
e- bb 11 l�S
•./.. f.
(Installer's Signature)
A ',
(Designer'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:\Septic\Designer Certification Form Revised.doc
IV;
ACCESS COVERS MUST BE WITHIN INSPECTION 9' MINIMUM. NVL R I EL. EVA I I ONS • DES GN CR l TER l A : GENERAL NOTES :
6' OF FINISH GRADE PORT 3 ' MAXIMUM COVER
101 . 75 r N'VERT Al- BUILDING: 99.4 _ DESIGN FLOW:
_ j� FIRST 2 ' TO I '
BE LF.VEI_, MIN 2' OF PEASTONE INVERT IN SEPTIC TANK: ^ 96.25 3 BEDROOMS AT 110 G.P.U. PER I . THIS PLAN /S FOR THE DESIGN AND CONSTRUCTION
- - .� -----��OR FILTER L TER FABRIC C OF THE SEWAGE DISPOSAL SYSTEM ONL4' DIAM Pip
✓.
_ INVERT OUT SEPTIC TANK: 98.0 BEDROOM EQUALS 330 G. P.D.
- 3/4 / 1/2' DIA. INVERT IN DIST. BOX: 96.57
\ "� 98. 0 iO• '�' DOUBLE WASHED STONE INVERT OUT DIST BOX: 96. 4 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS
99:4 - 96.4
98.25 GA 96.57 y 96. 33 --�---- L_._____._ 95_5___.. INVERT /N LEACH CHAMBER: 96. 33 SET. SEE SITE PLAN.
-------- BAFF,F SEPTIC TANK REQUIRED:
--- ----------- 3 OUTLET 4 HIGH CAPACITY INFILTRATOR BOTTOM OF LEACH CHAMBER: 95.5 330 G.P.D. X 200% - 660 GAL . J. ALL CONSTRUCTION METHODS AND MATERIALS AND
\ / D-BOX CHAMBERS W/3. 5 't STONE AROUND ADJUSTED GROUND WATER: N/A MAINTENANCE OF THE SEPTIC SYSTEM SHALL
1500 GAL \ i0 'r x 38 ' 1 x l0'd SEPTIC TANK PROVIDED: 1500 GAL . MIN.
OBSERVED GROUND WATER: N/A - CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL
SEPTIC TANK
6' CRUSHED .NONE OR BOTTOM OF TEST HOLE *I : 89. 1
50/L ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS.
COMPACTED BASE
DESIGN PEP,C RATE l 5 M l N/i NCH
PRO; If L F_ : NO T O SCALE SOIL TEXTURAL CLASS - I 4 ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER
EFFLUENT LOADING PATE - 0. 74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
r 330 GPD / 0. 74 GPG/SF - 446 S.F. RfOUiRED
THAN 3 ' IN DEPTH SHALL BE CAPABLE OF W/ TH-
V, I STANDING H-20 WHEEL LOADS.
`� PROVIDED: 4 HiGH CAPACITY INFILTRATOR
CHAMBERS W/3.5't STONE AROUND, A-460 S.F. 5. ALL SEWER PIPE_ SHALL BE SCHEDULE 40 PVC OR
460 S.F. x 0. 74 - J40 GPD APPROVED EQUAL .
C7`
S �. 1 -7 L C` _T_ p /� n �_ 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED
J i L._ t_ J i I T DA 1 A PRECAST CONCRETE OR APPROVED POLYETHYLENE
I AID ICATES _�j 'NDICATES BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER
PERCOLATION -_ OBSERVED TESTED FOR LEVEL WHEN THERE /S MORE THAN ONE
TEST - GROUNDWATER OUTLET.
' TP *I P TP *2
7 BEFORE CONSTRUCTION CALL 'DIG-SAFE".
\� HORIZON TEXTURE COLOR HORIZON TEXTURE' COLOR
L 0 7- I-888-D l G-SAFE AND THE LOCAL WATER DEPT.
1(
J / 0 0 99 6 0 =- F / L
99.6 FOR LOCATION OF UNDERGROUND JTIL I TIES.Y) C l
l
I . 486r S. F. s so \\��� v ALL. F / LL
3 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE
15• 98. 4 12'-- 98. 6 `
�G 0 ��c BM. CATCH 9A51N LOAMY IOYR LOAMY OYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION
y \� RIM-9b.b4 Q SAND 4/3 SAND 413 OF TrIF_ SYSTEM TO ALLOW FOR SCHEDULING OF THE
4 - PAVED 'RI Vf --
\Y _ w ---- �� '--^ 20 ' - 9? 9 i 8 98. l CONSTRUCTION INSPECTIONS.
t_GAMY 19YR - -- L�p LOAMY IOYR
I SAND 5/8 SAND 5/8 9. EXISTING CESSPOOL TO BE PUMPED DRY ANO
96. 6 36'-- 96.6 BACKr'ILLED.
✓?' CB/DH NI) t ousE �. l ME✓I U'M OYR - Ir MeD I UM I OYR
SAND AND 616 SAND AND 6/6
� �'� 50' GRA VE L - GRA VEL
� -
UP 16
\ NO WA T E.'R NO WA TER
126= 89. 1 120' ---------------- _ _ 89.6
/k,
1500 GAL'ON \�y0.
SEPTIC TANK \-\ P'z \o� _i s. _ DATE: AUGUST J. 20 i 0
71- / /l TEST BY: STEPHEN HAAS
CESSPOOL - TP*1 /��// / w W,'TNESSED BY: DAVE STANTON
PERC RATE: C 2 M1 N/I NCH
D-80X a � ,
\\r
Ktn7
1 S� c / "_ I�°/
00- , '�l/� 4 H/GH CAPACITY .
\�fN. INFILTRATOR CHAMBERS
cF W/3.5's STONE AROUND
0
.S� E 4D 7- / C- .S y S� -M Z D .S' / G/V
22 GROUSE- L ,4N IS- . MA 26r3 . PAPCEL 26 /
I
RA R IV S TA B L H . MA .
PREP,4 RED /= OF?
`VA � , ■ CB CONCRETE BOUND
WATER L I NE -
O hYDRANT 5' C.,4 L. E i - L? O ,4 U��US l� O
-- ---
LOCvS GAS LINE [----- ^ r - [-
"' 1 L� ff V [ II \ / E � I � �
GfiW ---- OVER HEAD WIRES L � l_J R V L- Y i I V (_7 � I I V �1
# LIGHT POST ` 923 Rou t e 6A
-E--- UNDERGROUND ELECTRIC LINE � �` �� � Ya r t h p o r t MA 02675
•� - -T--- UNDERGROUND TELEPHONE I NE ��i % /I/�� I/�� 5 0 8 � 3 6 2-8 1 3 2
1-po - CTV--- UNDERGROUND CABLEV/SION LINE ` ���/II �' ( 508 ) 432-5333
+ 40. 4 SPOT ELEVATION
__-40-- __ EXISTING CONTOUR
C i 0 20 40 4D PROPOSED CONTOUI? ------------- ----------- - ---- --- ------------------ ------------- - _------
L G C v S IV, P JOB NO: I 0-084 FIELD:CFW/EEK CAL C: SAh'/CFW CHECK: CFW )RV: SAH
I fImam