HomeMy WebLinkAbout0498 PITCHER'S WAY - Health 4978 tchers,Way
A= 291-022
1
TOWN OF BARNSTABLE
LOCATION_ GrnZJ"� W� SEWAGE# ®� "y
VILLAGE c,;��r � ASSESSOR' MAP&PARCEL �C�l P �a
INSTALLER'S NAME&PHONE NO. [C� �„�4(. �( ��►y ()��.
SEPTIC TANK CAPACITY \ ° L_rV'��X�C7� Ce;s-,.
LEACHING FACILITY-(type) -1 Ccc; 4 .14 (size)
NO.OF BEDROOMS
OWNER
PERMIT DATE:—�ja� f l� COMPLIANCE DATE: a
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
FURNISHED BY
13ts
4
Y .k
No. d` U!U ` —3/ Uv
i r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Tipplitation for &5pogal *pftem Coma ction Vertu
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. A
G�.,QJ S L).5;,y Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ell
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
s", � C KJ � aS� s 2� ,��a �13
Type of Building:
Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder (/(..QC)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 33 U gpd Design flow provided ® gpd
Plan Date x y l Z,k 1 t y Number of sheets Revision Date
Title
Size of Septic Tank tl Type of S.A.S. r r-
Description of Soil ^
`O
Nature of Repairs or Alterations(Answer when applicable) Q0(GC$ Q_X kZ& C QSS(JQc��
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. 0
Signed Date / V 1�y I f D
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. _ 0 (u - ( 3 ( Date Issued
• r
No. d U I V ""` Fee UJ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
3 Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppYication for migoal 6patm Cowgtruction Permit
i Application for Permit to Construct( ) Repair(Upgrade( ) Abandon( ) Com lete System
p y ❑Individual Components
Location Address or Lot No. k `,\�`�.QJ S`'�wc, Owner's Name,Address,and Tel.No. 4
'r1 Cis•n�k! �.� ('�
Assessor's Map/Parcel �., ea
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
s 3� �� &J "tit 5- 1 .Gs Pc.r,
Type of Building: g
Dwelling No.of Bedrooms fil Lot Size sq. ft. Garbage Grinder
i
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
required)Flow Design re
g ( q ) �-3 U gpd Design flow provided :?(n D gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank 5'�11 Type of S.A.S. _ �J
Description of Soil IN
i
G.f
j
Nature of Repairs or Alterations(Answer when applicable) (L X\S� C QS`�OC_St
i? N
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 / V �.S 1 (6
A hcafion Approved b
i PP PP Y t Date /i _t
Application Disapproved by: Date I
for the following reasons
Permit No. O (u - y Date Issued )U /v
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (1/) Upgraded ( )
Abandoned( )by SCd C.n�L
at r� -A Vic has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Const ction Permit No. 0/9 - t/ ?/ dated lul.2ill.
Installer S CO t- \C e-rl�vll_ Designer
#bedrooms Approved design flow ? gpd
The issuance of this ermit shall not be construed as a guarantee that the system wild°Fu'n''sYib. as desi_ned.
Date Inspector✓'Ap e
. .
No . Fee ll,�l-�-- -- •-- -- - --
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
lwigool *p!5tem Construction Permit
Permission is hereby granted to Construct ( ) Repair '( � Upgrade ( ) Abandon ( )
System located at l4.91
I 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 oft it is pe.�t.
Date f��) 1(Q Approved by ,� �M4 a.^,
Town of Barnstable
OF SME Tp�
Regulatory Services
- �- Thomas F,Geiler, Director
• swlwsrABM
1639. Public Health Division
AIFDMA+A Thomas McKean,Director
200.Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 1 I t ` Sewage Permit# ` .p_ j1 Assessor's Map\Parcel 3ci x-2a
Designer: ��� (-E�-►`1 J�. "AA!, QE Installer: Sc_en-T— q.
EA4 C—e
Address: 9Z2, R&ym A Address: 113 6t_b IeA4 46-cnt
H A. y2loc,
On lolls, I t,,� 1-�(. /N,�1� was issued a permit to install a
(date) (installer)
septic system at P,kc�.�s6 c„s based on a design drawn by
(address
5 to PHA A. 14AA% 5'i�E 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 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. V.
�,,.;. ,,�,
Installer s i nature 3
At
(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 BA)INSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Revised.doc
Town.of Barnstable P# / 3
Department of Regulatory Services
Public Health Division Date
�ArFo,�,yw�b� 200 Main Street,Hyannis MA 02601
Date Scheduled 0
Time r f Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By: /+4 r
Witnessed By: u y; W, LA��j,k2
LOCATION& GENERAL INFORMATION ��-`may--
Loca[ion Address �` n `
v�� V J Owner's Name ���
�y Address
Assessor's Map/Parcel: p,.�.. v 2 C�
( �— Engineer's Name S�/,%z z cc-)
NEW CONSTRUCTION REPAIR h �
Telephone# .ae
Land Use R 97:5 t b 6V,51'1,LSlopes(rYo) +'_
Surface Stones AJ CJ
Distances from: Open Water Body ft Possible Wet Area d
ft Drinking Water Well ft
Drainage Way. It Property Line d—o/
ft Other ` ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands In proximity to holes)
Parent material(geologic) �aas`T36f,a9�a1
Depth to Bedrock >Zcw
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Fuse /�/i4 A-
Estimated Seasonal High Groundwater /l.a//4 � ^
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: AXR AJ C.
Depth Observed standing in obs.hole:
Depth to weeping from side of obs.hole: Depth to soil mottles:
Readi in
Index Well# in. GroundwaterAdjustment,
Reading Date: index Well level Adl,factor Adj.Groundwater lxvel
PERCOLATION TESL' bt,tp� lv Tfine FH,Ie
4 Time at 9"
ptoPere _
Time at 6"
Start Pre-soak Time @ l)L 610
Timd(9"-6")
End Pre-soak 00
Rate Min./Inch � ►
Site Suitability Assessment. Site Passed Site Failed:
Additional Testing Needed(YIN)
Original:Public Health Division-
_ Observation Hole DataTta 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\.PERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
qq isten %Gravel)
24,
DEEP OBSERVATION HOLE LOG Hole# 2—
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA)
(Mansell) Mottling (Structure,Stones,Boulders.
Consi tency.%Grave
to Yk Z&
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Con i to c o Grave
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consi ten l
I'i..A Insurance Rate Map'
` Above 500 year flood boundary No_ Yes .
Within 500yearboundary No -Yes
Within 100 year flood boundary No z Yes
Depth of Nati-irally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for tije soil absorption system? LA&S
If not,what is the depth of naturally occurring pervious material?
Certificatio.I I certify that on. E 141 A q (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, xpertise and experience described in 310 CMR 15.017.
Signature_ Date `� ��- 4
Q:\.S.EPnC\I'ERCFORM.DOC
77 71
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X, CR I T* ENERA L NOTES
DES
VER
7
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A CCESS 'CO`VERS_:MU!T 8 E WI THIN ArSPEMON 9"�*INIkuM: CL
ER,I A
POR MAXIMUM 'CdVER'
iOF,F1'k'1SH GRAD- !,,, ,�, , � , .,G
T_ A' WELL)NG
--jNVERF, 7,1D D SIGN FLOW:
�'2 �TO,
10 1.56 FIRST, 71
0 AT' l WG.P�D. PER I. THIS PLAN I -FOR ,TIIE DES I GN AND CONSTRUCTION
BE- EVE4,
INVERT Af �SEPTIC TA NK 3,BEDROOMS
96.75 �'Pt6ROOU EO 5
TIC TA Kr
0 'BOX:
N VE�R T'I N D I T�--,
CAL A UY NO GARBAGE GRINDER 'ASSUMED. �Fo RKS
K,7
.ND BACKFILL Y. S
'AND 2- 'OVER CHAMBERS - I s�t 4 INVERT OUT D
SET, EE SITE PLAN.
GAS '''INVERT -IN LEAC CHAMBER: 96"42
5 .5
97, 19 SEP T C,: RED:
A�F�F4 TANK RE101U1
BOTTOM F
LEACH, 'CHAMBER 95.5
'THO 5 AND MATERIALS AND
10 HI -APACI'TY Mr I TkA TOR 330 ,G.P.0 X-20OX 660' GAL.'
3�'OUTLEr 3. . ALL CONS TRUCT I ON ME D
'TRENCH FORMATION -ADJUSTED 6 OUND WA TER �NIA
UERS R PROVIDED: 1500 GAL MIN MA N TEAIA NCE,OF THE, SEPTI YS TtM 'S
D-BOX C S HALL'
OBSEff VED"GROUND' WA TER.
1500'-6AC. NIA
CONFORM TO M4 SS.,.:D.E.P. :TI TLE '5 AND LOCAL
SEP T C TANK 80 TTOk b)E*ltES`T HOLE #1 89,'TONE OR,
6 �CRUSHED SOIL'ABSORPT,16N SYSTEM REQUIRED: BOARD OF HEAL TH,REGULATIONS.
DES I GN PEC iR' ATE 5,-M INI NCH
COMPACTED BASE :
'AL -SEPTIC S YSEM COMPONENTS L OCA TED UNDER
4.
CLASS
T. ro XA El
PROF :,NO
;AREAS SUBJECT TO, VEHICULAR �TRAFFIC OR GREATER
0.
EFFL UENTL OAO NG RA TE 74 GPDISF
330 GPD 0,74.6PDISF - 446 S.F,. 'REQUIRED THAN 3 IN DEP TH SA t L BE,CAPABLE, OF,W1 T14
STANDING H-20 WHEEL LOADS.
-PROVIDED:
Y TO
/0 HIGH ,CAPACIT INFILTA R*
CHAMBERS N TRENCH, 62.5 LF x 7.79 SFILF 5. ALL SEWER PIPE SHAL L Br.SCHEDULE 40 OR
360 GPD APPROVED EQUAL.
SF,,x .�74 :OPDISF
6. SEPTIC ,TANK AND D-BOX SHALL BE REINFORCED
'PRECAST CONCRETF,,AND WATERTIGHT 'D-BOX SHALL '
BE WA TER TES TED �,TO CHECK "FOR LEVEL Wil IEN THERE
'OUTLET.
IS MORE 'THAN 'ONE:
7. BEFORE,i CONS TRUCtl ON CALL 'DIG-SAFE-:
1-888- -SAFE AND THE; LOCAL WA TER DEP T.'�
P 1,G
UNDERGROUND UTILITIES. .
FOR L OCA rl
8. EY
I S T NO CS
$POOL TO BE PUMPED DRY AN
'30-F
N�86*62
'L INK i
FENCE
CHAIN
CESSPOOL
8M-CORNER OF
7
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STEP. awl&-63- PARCF
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