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HomeMy WebLinkAbout0094 OLD TOWN ROAD - Health 94 Old Town Road Hyannis A = 268 — 085 TOWN OF BARNSTABLE 2 � ;OCATION '6-1 d (�taa�i ��� ~ SEWAGE# vILL'AGE ASSESSOR'S MAP&PARCEL . D1,STALLER'S NAME&PHONE NO.� " SEPTIC TANK CAPACITY I. -f7 U H r {-I o�0 _.LEACHING FACILITY:(type) l�dl ® h' �n (size) /�. Y a`��C d FA - " ' :NO'OF BEDROOMSC f OWNER 'v, .0 > c�, 2,1�9C) N'vR ter' a 'PERMIT DATE '/h ya s Il S COMPLIANCE DATE: // Ia� r t " x x Separation Distance Between the: t Maximum Adjusted Groundwater Table to the Bottom of.Leachmg Facihtyry Feet 7(. ' }Private Water Supply Well and Leaching Facility(If any wells exist on f: site or within 200 feet of leaching facility) r• _ ' ,� sk k, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within..w�; 300 feet of leaching facility) `` Feet` ,ti FURNISHED BV,,, ,. ,� N 14 .. n 14, i e-6 d to O ._- r No. J — Fee Ov THE COMMONWEALTH OF MASSACHUSETTS Entered in computer' PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2[pplitation for Misposal *psteitt Construction Permit Application for a Permit to Construct( ) Repair(-�Upgrade( ) Abandon( ) Q Complete System ❑Individual Components Location Address or Lot No. Ot%-1 (� �- 0 O1�ner's Name, ddre�ss>and Tel.No. i y 6%G� �O bCT t t, -(.0rn�) Assessor's Map/Parcel --C)6 v,Fn I f o� k Wh ^nV Installer's Name Address a d Tel.No..S esigner's Name,Address,and Tel.No. GZ �cr�— l. off^ 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) gpd Design flow provided �?a gpd Plan Date I®I [E ! I.3 Number of sheets Revision Date Title _ Size of Septic Tank t�Od Type of S.A.S. Description of Soil M,e _e C p c4-56-� . ZNr.,_^r I� Nature of Repairs or Alterations(Answer when applicable) Ad w ! S7 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. ` d Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.��T— �� Date Issued p 2 r b No. d I J — / Fee O✓ , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpYication for Misposar *pstem Construction permit Application for a Permit to Construct( ) Repair(—)"Upgrade( ) Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. t d o q^_ "` O%vner's ame, ddre s,and el.No. L'Y01 a eNJ.QC-(0Orn,-_,) Assessor's Map/Parcel oC`j �� (���/1 J -tq nkl Installer's Name Address a d TO No.�t7 01� Designer's Name,Address,and Tel.No. S cv N L t�3 �J �a.��i� "fie ���Gc s't�sr 3 t, a Type of Building: 4 Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( OP Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided o gpd Plan Date t C' 1,� 13 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. C\CA,,VA JJ Description of Soil Nature of Repairs or Alterations(Answer when applicable) A 1 rJ I_X3 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. t d Date 1� Application Approved by ly vel 0 , Date 1 t / — Application Disapproved by Date for the following reasons Permit No. r/f 3� 2S Date Issued O J ------------------------------------------------ ------------------------------------- i 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 �� �R at C� C>&, ��` instructed in accordance with the provisions of Title 5 and the for Disposal System Construc ion Permit No tl O 3 7rdated v q / Installer Designer #bedrooms Approved design flow ///� V gpd The issuanc of his permit shall not be construed as a guarantee that the system will function as desigtiedl i ✓' Date a � Inspector ----- ----- -�� r =•�- --------------------------------------------------- ---------------------------------- --- -'-------- No. 2 7S Fee / ©Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS his osal 1 stem Construction permit � p Permission is hereby granted to Construct( ) Repair( �7 Upgrade( ) Abandon( ) System located at ��.( Ck j W r\ C� �'I�Cr'�• n'�� 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 m st be completed within three years of the date of this permit. Date f / Approved by "W ��� Town of Barnstable fn+e,gy�o Regulatory Services Richard V.Scali, Interim Director 3ARN8TABLE. 9� '& ��� Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: J Sewage Permit# i Tj MAssessor's Map\Parcel Designer: X. 1Y.y►A-% Installer: co k r-oW�_ Address: g23 /Zorv-,-F= 6,4 Address: YC"rrn e1 y fz r M On A fail►-s— c-o H FvY�- V- was issued a permit to install a (date) (installer) septic system at 7V Old based on a design drawn by (address) ,p dated /C� I 1.$" (designer) V/--1 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 in compliance with the terms of the IAA approval letters (if applicable) 4f (Inst 's Signature) c • 6do.3�4A1 (Designer's Signa e) (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:ASeptic\Desiger Certification Form Rev 8'=14-11doc I } Town of Barnstable P# EVE Department of Regulatory Services Public Health Division Date t S- MA89 200 Main Street,Hyannis MA 02601 . �Arft)hlA'1 t, C� 3O . Date Scheduled u Time Fee Pd.— W �� Q Soil Suitability Assessment for Sewa� e Dispos I Performed-By: "y�� � � �C Witnessed By: J t L /e LOCATION&.GENEW INFORMATION l ' r Location Address <., /�lJ,` (� Owner's Name 1 � �j'�J "l � / ��G�t\`1 t��� •� Address Assessor's Map/Parcel:�i Engineer's Name S• _. `C NEW CONSTRUCTION REPAIR Telephone# f 3 Land Use Slopes('%) G.,~" Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well � ft Drainage Way ; ft Property Line ry ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands{n proximity to holes) Parent material(geologic) h Depth to Bedrock "',y+ Depth to Groundwater. Standing Water in Hole: N(x Weeping from Pit Face Estimated Seasonal High Groundwater Ij DETE HNATION 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__ _,,,_,,,,— Adf,thetor A41.Groundwater Level e PERCOLATION TEST gate It Thne fo 1-S Observation. Hole# Time at 9" , Depth of Pere Time at 6" • 0rE'�, Start Pre-soak Time @ 'Time:(9"-6" End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed_I 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:\SEPTIM.ERCFORM.DOC DEEROBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsistencv.%Gravel) 2-1 DEEP OBSERVATION HOLE LOG Hole# �- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ,i Le DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA)- (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stores;Boulders. C Flood Insurance Rate Man: Above 500 year flood boundary No— Yes 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 area proposed for the soil absorption system? -- If not,what is the depth of naturally occurring pervious material? Certification I certify that on I1' •/4, (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 tramin ertise and experience described in 410 CMR 15.017. __ ... . Date /a /�' 2:-cs/S� Signature QAS.EFnWERCFORM.DOC ACCESS COVERS MUST BE WITHIN 9" MIN/MUM. INVERT ELEVATIONS : DES l GN CR l TER / A : GENERAL NO TES 6" OF F t N l SH GRADE 3' MAX/MUM COVER l04.4 FIRST 2' TO INVERT AT BUILDING: 102.4 DESIGN FLOW: BE LEVEL MIN 2" OF PEASTONE INVERT IN SEPTIC TANK: 101.5 2 BEDROOMS AT 1/0 G.P.D. PER I. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION OR F I L TER FABRIC ,INVERT OUT SEPTIC TANK. !0/.25 BEDROOM EQUALS 220 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM ONLY. 4` 01AM PIPE INVERT 1N 0/ST. BOX: 101. l7 '. 3/4" - 1 1/2' D l A. NO GARBAGE GRINDER NDER 2. VER T 1 CAL DATUM IS ASSUMED. FOR BENCH MARKS 1�02.4 "� t 0/.25 /01.0 2 �' DOUBLE WASHED STONE ;INVERT OUT O1 ST. BOX: lO!•0 SET. SEE S/TE PLAN. IO/.$ cas l0l. !7 o 100.9 °v 98.9 INVERT IN LEACH CHAMBER: 100.9 BAFFLE -`-" SEPTIC TANK REQUIRED: u, 3 OUTLET 2-500 GAL LEACHING CHAMBERS BOTTOM OF LEACH CHAMBER: 98.9 220 G.P.D. X 200x - 440 GAL. J. ALL CONSTRUCTION METHODS AND MATERIALS AND �v 0-BOX py/4 STONE AROUND. 12.8'W x 25'1 x 2'd ADJUSTED GROUND WATER: N7A SEPTIC TANK PROVIDED: 1500 GAL. MIN. MAINTENANCE OF THE SEPTIC SYSTEM SHALL 1500 GAL H-20 ­08SERVED GROUND WATER: NIA CONFORM TO MASS. D.E.P. TITLE $ AND LOCAL SEPTIC TANK 6" CRUSHED STONE OR BOTTOM OF TEST HOLE *1: 93.3 SOIL ABSORPTION SYSTEM REQUIRED: BOARD OF HEALTH REGULATIONS. 7 COMPACTED BASE DESIGN PERC RATE C 5 MIN/INCH \V► PROF l L E : NOT TO SCALE SOIL TEXTURAL CLASS - ! 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER EFFLUENT LOADING RATE - 0.74 GPD/SF AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER 220 GPD / 0.74 GPD/SF - 298 S.F. REQUIRED THAN 3• IN DEPTH SHALL BE CAPABLE OF W1TH- STANDING H-20 WHEEL LOADS. PROVIDED: 2-500 GAL LEACHING CHAMBERS W/4' STONE AROUND. A-471 S.F. 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 PVC OR 471 S.F. x 0.74 - 348 G.P.D. APPROVED EQUAL. SOIL TEST PIT` DATA& 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED PRECAST CONCRETE OR APPROVED POL YETHYL ENE. INDICATES N7 INDICATES PERCOLATION OBSERVED BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER _,. rEsr - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE TP #1 P•14841 TP s2 OUTLET. HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR o` 103 3" o 103.5 A LOAMY IOYR A LOAMY IOYR 7. BEFORE CONSTRUCTION CALL 'DIG-SAFE". SAND 212 , SAND 2iz l-888-DIG-SAFE AND THE LOCAL WATER DEPT. 5` - - - - - - - - - - - - - - - 102.9 6` - - - - - - - - - - - - 102.8 FOR LOCATION OF UNDERGROUND UTILITIES. UP 217-6 B LOAMY IOYR B LOAMY IOYR - SAND 316 SAND 316 20` - - - - - - - - - - - - - 101.6 22, - - - - - - - - - - - - - - - 101.5 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE - C l MEDI UW IOYR C� MEDI UW IOYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION SAND AND $16 SAND AAO 616 GRAVEL GRAVEL OF THE SYSTEM TO ALLOW FOR SCHEDULING OF THE S UN1? I,S E TERRACE CONSTRUCTION INSPECTIONS. 44' \\\ 104 9. EX 1ST 1 NG CESSPOOL TO BE PUMPED DRY AND / l03.3 EDGE OF GRAVEL ROAAP / "`{� BACKF 1 L L ED. 102,6 NO WATER NO WATER 12 93.3 /? 93.3 104.3 / l 2-500 GALLON l DATE: OCTOBER /3. 2015 LEACHING CHAMBERS ( TEST BY: STEPHEN HAAS +103.6 W14' STONE \ WITNESSED BY: DAVID STANTON ld2 9 PERC RATE• ! 2 MIN/INCH o i / 20, A R f�A D-BGX 6 \ p 7.55611 S.F. .>. o +__ 5 i J EXISTING /03. io9 I \ oJ JJ DWEL L!NG ' 1 J( W----1- .-._.1w OCESSPOOL I03.8 p ( 1500 GALLON n \ SEPTIC TANK TPa2 Tps/ 1 �'y waV l BM. TOF BLOCK f1 k O ( EL-104.4 ( 129.84' t 1 +103.2 +,03 , SEPT / C SYSTEM LIES I ON +102.3 94 OLD TOWN ROAD . MAP 268 . PARCEL 85 BARNS T,ABL E . ( h-IYANIV l S ) MA PREPAReD FOR : ro � LEG L YD l A NER B ONNE � 0 co CO'.CONCRETE BOUND LOCUS O ``HYDRANT I NE S CA L E : l 2 0 ' O C T O B E R IS . 2 0 / S G GAS# L INE EACH Rp OHW OVER HEAD WIRES S T E P E N A . H A A J GRAI V1LL LIGHT POST ENGINEERING , INC --E-- UNDERGROUND ELECTR 1 C LINE , �, p . O . B a x 16 ---T_ UNDERGROUND TELEPHONE LINE NE �` � / ,.- � � South Penn i s MA 02660 ( 508 � 362-8 t 32 -�CTV- UNDERGROUND CABLEV/SiON LINE +40.4 SPOT ELEVATION ­__­ L 40....... EXISTING CONTOUR L O CV S MA l p 0 I 0 20 40 S 71 PROPOSED CONTOUR JOB NO: l 5-052