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Home My WebLink About0009 KELLEY ROAD - Health ' HydlullS ----- - - ---= - - - - - 1A 292 072 - - -- - - - -- --- -- o i i "n Ir rt 1 p TOWN OF BARNSTABLE LOCATION / L�x �� SEWAGE# 015'�JO� VILLAGE /��'�I✓✓o''�� ASSESSOR'S MAP&PARCEL07,96-t " INSTALLER'S NAME&PHONE NO: `rnn` - i - y SEPTIC TANK CAPACITY Ae �!�1)}�ro o .G-�z!'o A,,, 1�f,r,� `• LEACHING FACILITY- (type) ®�''' e�c`T�' (size) NO.OF BEDROOMS .3 "•��rn OWNER ��t✓'/�✓ , PERMIT DATE: �� COMPLIANCE DATE: 3 U Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leac ih ng Facility XZ Feet Private Water Supply Well and Leaching Facility(If any wells exist on / site or within 200 feet of leaching facility) J Feet Edje of Wetland and Leaching Facility(If any wetlands exist within / 300 feet of leaching facility) ,/ Feet FURNISHED BY I n0 r� • L � , M 0 t Cl +-5 rq r ri r No. / Fee �. THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS apphLatioti for iBispo8al 6pstrm Construction VermIt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. �,/_�ZZky A�nA0 wner's Name,Address,and Tel.No. Assessor's Map/Parcel � P a— O?e Installer's Name,Address,and 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 e5?dPj No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3.70 gpd Design flow provided �, gpd Plan Date —" oT� �� Number of sheets ,/ Revision Date Title Size of Septic Tank A' dl �3`O O 6:X;7 Z 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 Board of Health. Si Date �- Application Approved by Date Application Disapproved by Date for the following reasons Permit No. a Date Issued 4' No.� +„ -- Fee 111777' 1�•�� " 'THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplicatlon for aisposaf%;'6pstem Construction Permit t, Application for a Permit to Construct( ) Repair( _). Upgrade( ) Abandon( ) Complete System_.-.Q Individual-Components--•-- Location Address or Lot No. wner's Name,Address,and Tel.No. 6• Assessor's Map/Parcel Installer's Name,Address,and Tel.No. f 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(min.required) 3,?O gpd Design flow provided �91` gpd Plan Date �Number of sheets / Revision Date xs Title Size of Septic Tank ��/ "ro O�l�1 Type of S.A.S. C"G'^' - Description of Soil SEc�" 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 Board of Health. Si a .-. Date / Application Approved by / Date y Application Disapproved by .Date 1 for the-following reasons I Permit No. Date Issued TIC E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(� Repaired( ) Upgraded( ) Abandoned( )by 1__1490e_l z J'4de�/C i at 9 .FELG G�/J /jay has been cons ucted i cco/rdann-e with the provisions of Title 5 and the for Disposal System Construction Permit No (/d'_at'ed Installer C:/ A" �/Gr'I�OCC<✓/� Designer G/ .!'G�� -r i #bedrooms Approved design flo gpd The issuance o this jermit shall not be construed as a guarantee that the system wi l fimc�pn as design . Date LlI Inspector Q J -T - = - --- - ------------- - _- . _ _ - `-- - _ _ --_ -- No. Fee THE COMMONWEALTH OF MASSACHUSETTS T�— i PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( � Repair( ) Upgrade( ) Abandon( ) System located at �•t C" and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with -y—�y Title 5 and the following local provisions o special,conditions. Provided:Construction ust be completed within three years of the date of this permit. Date Approved b 'es PP Y 1 MAY/01/2015/FRI 09:55 AM FAX No. P. 001 Town ofarnsable F ►°wy Regulatory Services Richard'V.Scali,I►ateritn Director HAJUVWAIIIZ XAM - Public Health Division Thomas McKean,Director . . 200 Ma;n Street,Hyannis,N A 02601 Office- 508-862-464.4 Fax: 508-790-6304 Installer&Designer Certification Form Date: 1 Sewage Permit#A�/r SOS Assessor's MapTarceld,,9X 7nZ Designer: I InstalIer:��1 Address: �" Ci Address: was issued a permit to install a (date), �j (installer) septic system at 1.q4f aA P abased on a design drawn by (lad&ess) M) t`-"'"" dated </-4a— Xr (designer) 1� 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. Strip out (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 of the septic system) but in accordance with State& Local Regulations. Plan revision,-or certified as-built by designer to follow. Strip out(if required)was inspected and'the soils. � were found satisfactory. I certify that'the system referenced above was constructed ' nce with the terms of the I\A approval letters(if applicable) . �N OF �4 �GoJ, �scT' DAVID 9�y 7 ' o j MASON u," � alley s Signa 4 —+ No.toss i �Grsr��w oir R\.- esigm .nature) (Affx Desio � p Here) t. PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COIYIPLLANCE WILL NOT BE ISSUED UNTIL BOTH TFfIS FOPM AND AS- BUILT CARD ARE RECEIVED BY THE 13ARNSTABLE PUBLIC HEALTH DIVISION. ' THANK YOU. '�- QASapticlDesignar Certification Forth kav 8-14-P.doe C),j&, Town of Barnstable P# Department of Regulatory Services ? a,O M i Public Health Division Date q �q 200 Main Street,Hyannis MA 02601 - lEU Date Scheduled /' "` � I tj Ma Time Fee Pd. ►foil Suitability Assessment, or ►sewage ispostal Performed By: _ < I. � S Y Witnessed By: ` W I`/� Q LOCATION& GENERAL INFORMATION Location Address %.- A 2ty �� Owner's Name 'C/ 'GMT Address Assessor's Map/Parcel: '�9� - D7.> Engineer's Name ✓h'�� '��`�'�� NEW CONSTRUCTION REPAIR- �--- Telephonetk6� Land Use. Slopes(46) Surface Stones Distances from; Open Water Body- ft� Possible Wet Area 8 Drinking Water Well ft Drainage Way " 11 Property Line -= ft Other ft SKETCH:(Street name,dimensions of lot exact locations of test holes&perc tests,locate wetlands in proximity to holes) v • Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Watei in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater-L - T� �y� � •- - DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used Depth Observed standing in obs.hole: In, Depth to soil mottles: Depth to weeping from side of obs.hole: In, Groundwater Adjustment Et: Index Well# Reading Date: Index Well level___ __Y_ Adj,factor Adj.Groundwater Level e . • PERCOLATION TEST Date_._ time Observation Hole# Time at 9" neDepth of Perc Time at 6" Start Pre-soak Time @ 'lime(9"41 End Pre-soak .. Rate Min./Inch - Ot l 1 l Site Suitability Assessment: •Site Passed Site Failed: Additional Testing Needed(YIN) �J Original: Public Health Division fi ' 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'VPERCFORM.DOC 1 i •DEEP.OBSERVATION HOLE LOG hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stn'cture,Stones;Boulders. onsistency.%Gravel) a o YleVf DEI;✓P OBS]E1�VATION HOLE LOB Hole# Depth from Soil Horizon Soil Texture ,•Soil Color Soil Other Surface(in.) (USDA) ` (Munsell) Mottling' (Structure,Stones,Boulders. Consistency,% a DEEP OBSERVATION BOLE LOG Mole# Depth from Soil Horizon Soil Texture Soil Color , Soil Other Surface(in.) • (USDA) {f (Muosell) Mottling (Structure,Stones,Boulders. ` Consistency,%O DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency, I " Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Y es .� Within 100 year flood boundary No. Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery o at dal exist in all areas observed throughout the area proposed for the.soil absorption system? If not,what is the depth of naturally occurring pervious material? • Certification `. I certify that on (date)I have passed the soil-evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the r uired training,exp s a experience described in 4510 CMR 15.017. Signatu Date ti Q:4S.ElynCU?ERCFORM.DOC ASSESSORS MAP : -- 2q Z _--_ ____._._ _ - TEST HOLE LOGS PARCEL : �� 1) The installation shall cornt7� with Title V and "Town of� FLOOD ZONE: SOIL EVALUATOR � *&Board of �� _--._-.__ ___.._ . 1 lealth Regulations. 1 � , • WITNESS : I � 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: � - i /ZZ�B .�, 6__; DATE: components prior to installation and setting base elevations. __-. __._._ _._ _ _..._ . _ _. -- - --- e�--- PERCOLATION RATE: G. '�7� lV �� 1 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first v � A4t4 _—�i ` ><C�L.�J \Iv two feet out of the d-box to the leachingshall be level. TH- I TH-2 4) This plan is not to be utilized for property line determination nor any other _I&C A purpose other than the proposed system installation. ��A L,0_'fL 'INV4 IIb �� I� I 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over E110 septic components. \�C21 'A qo� I,0 ,�tq,� y (,p 5jn,�7 7) The property is bounded by property corners and property lines. 11D q1 (p `� 8) The property owner shall review design considerations to approve of total l� ( 1 P 2 Pd I /� 0 ` 1 design flow and number of bedrooms to be considered for design. Receipt LOCATION MAP a 31 - a �? g g p 70 • �A of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall v • � q_ q be removed along with contaminated soil and replaced with clean sand per 4 a ��\� W�� p � Title V specs. 6 ` s �a J 1 ✓ 10)System components to be 10 feet from water line. Sewer !fines crossing the water line shall be sleeved with 4 inch SC1140 PVC with ends grouted if ��lo�o� applicable. The proposed SAS is being installed below the water service .7 line. The line is to be sleeved as aforementioned and maintained in place. SEPT I C SYSTEM DES I G N 11) 1f a garbage grinder exists it is to be removed and is the responsibility of the ' owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if such exists. 13 Tile installer shall verify the location, � � (� ,�, /� • , ° ,� � BEDROOMS AT II:� GAL/DAY/BEDROOM �"��GAL/DAY ) y quantity and elevation of the sewer lines exiting the dwelling`rior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting p --- Title V requirements. ,; GAL/DAY x 2 DAYS - GAL r a 4, yn r 6 ' USE ! GALLON SEPTIC TANK N _ � h d 0 7/ v 1 S01L A ABSP TION SYREM 00 •" ,,, 4444 � ti O �� & COAVID p' 1� ,' S I DE AREA: 2y\ 's., -t� ))C ZX O�-Z = f I,�7 B. r oN �v BOTTOM AREA: , 217 % ?J7� 7� MASON \ /S,T.E� k No.1066 \�� SEPT I C SYSTEM SECTION 471 DF mat 00 , o 10 I io vo 6� ��, C 4�_$rL�F t, ► �,'7Z �aDp 21,E �8,. ,5 rcxr._a lwa 6"xchx, Aq GAL Iwrdo SEPTIC TANK1— �1 7 T 0 O , SITE AND SEWAGE PLAN 't, LOCATION : 9 � �C I - ZO 0 PREPARED FOR : �. CIS � M rr m Q SCALE: I " ID 0. DAV I D B . MASON RS DATE: 4 ZZ ZDI DBC ENVIRONMENIfAL DESIGNS Z EAST SANDWICH . MA W DATE HEALTH AGENT ( 508 ) 833— 2 177 3 W Z