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HomeMy WebLinkAbout0023 PLEASANT PARK AVE - Health 23 Pleasarit.Park,Ave; . Hyannis A=249— 139 No0-05- 3b s Fee (2!0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Mi!6paar 6pgtem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade(J)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. a 3 J ct, }- q rat A� Owner's Name,Address and Tel.No. Assessor'sMap/Parcel Q[ / Q _ I � ,Y`S C &�{ Installer's Name,Ad&esSa�d�G l Designer's Name,Address and Tel.No. 350 Main Street ��e r' W. Yarmouth MA 02673 -- �-- Type of Building: —..���+ua1 Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 8 Design Flow gallons per day. Calculated daily flow -- gallons. Plan Date Number of sheets / Revision Date moth/ Title CL t-c — c�rGJ�-Ce Size of Septic Tank /S6.0 Type of S.A.S. r Description of Soil �P r 4/7 1 Nature of Repairs or Alterations(Answer when applicable) P�l� 1A-✓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 Certifi- cate of Compliance has been issued by this Boar A Heal ."" Signed Date 16 d 0S� Application Approved by Date Application Disapproved for°the following 4 Permit No. Date Issued No �/�J` ' Fee 0 U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS. s 01ppYication for Migpogar *pgtem Con!5truction Permit Application for a Permit to Construct(" ,)Repair( )Upgrade(Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. a 3 I.e ;+"� A Owner's Name,Address and Tel.No. µ ^� Assessor's Map/Parcel N IS /Vl C d L! 9 _ ' Installer's Name,Address,and Tel.No. 111 Designer's Name,Address and Tel.No. Type of Building: �--a Rdb,A, de(- rer) , r�.P. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures d Design Flow 334 gallons per day. Calculated daily flow PP PO2 gallons. Plan Date 6 - t- 5-- Number of sheets I Revision Date Title Sr(.1A-q le -Size of Septic Tank /.S O Type of S.A.S. Description of Soil ��f /�14 Nature of Repairs or Alterations(Answer when applicable) P-r d 1A h 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 issued by this Boar o Heal . Signed C L L L U4 Date /a,/``id .Sr_ Application Approved by v -tyW P Date 01 M J h Application Disapproved for the following re s s Permit No. J Date Issued THE COMMONWEALTH OF MASSACHUSETTS lll"' BARNSTABLE, MASSACHUSETTS bc Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded( (),-' Abandoned( ) l 'U C U at c P/eG, f{„ A (^� � L,,', — I-) �l n i S s constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, _ J dated Installer - Designer The issuance o+f this ermit shall not be construed as a guarantee that the s� to w' 1 unction as/ sigue, Date t 3 �� Inspector �!/ . ' = / —��•—„lam! ..��----- --------.---------- —No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE S MASSACHUSETTS lwi!6po5ai *p5tem Construction Permit Permission is hereby granted to Construct( )Repair r( )Upgrade( Abandon( )'/ I System located at o)3 Pl e R.f Ph ILf A/`�i� /-�vim- i -/1' r /�/ 15 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 beompleted within three years of the date of this •e its Date: / l/a'I I�77 Approved b fl l t _ TOWN OF BARNSTABLE LOCATION z EE Sns t-r� � �J SEWAGE# J�' VILLAGE Y r}wt nt 5 ASSESSOR'S MAP&LOT 2 /-13 INSTALLER'S NAME&PHONE NO. l� C.4(VCa 8- 77 S-Z 6-c-0 SEPTIC TANK CAPACITY 1 y® H— 10 LEACHING FACILITY:(type) (size) NO.OF BEDROOMS ee BUILDER OR OWNER c G PERMIT DATE: { COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Fumished by i A- P'T 3 p TOWN OF BARNSTABLE Lr,�jCATION a 3 r i 4 ASA tiT SEWAGE # S-egti G, V�LLAGE 14yA.tyis - 014 ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size)NO. OF BEDROOMS O wl PRIVATE WELL OR PUBLIC WATER P4l 11'c., h BUILDER OR OWNER I A-T R i DATE PERMIT I. � ISSUED: Jr DATE VARIANCE GRANTED: Yes No tA C e ®. lw w a� II ,e d b R K i4 v III Town of Barnstable WE Regulatory Services y4rP Os . ........-... Thomas F. Geiler,Director • snxxsTnars. • qj �0 Public Health Division t61q. AIEo �a Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: lD 3l 10, Designer: Installer: Address: P-Q - 6N, T d j .Address: 350 Main Street 'Q 1j l C4 _02.S 31 Yarmouth, 3 On 14A rAlu(o was issued a permit to install a (date) (installer) Q,, septic system at J.3 f L �1 PftP- rJ , based on a design drawn by (address) � 7 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 Re ations. Plan revision or certified as-built by designer to follow. OF Aggss�c - DARRENM. �N - J NG c�i M E (Installers Signature) 4 o CNil 1, /sTEa� SgIVITARINM VVUA_ (Designers Signatur (Affix Designer's Stamp Here) PLEASE RETURN TO tBARNSTABLE 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:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair.Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated concerning the property located at 23 PL4EASAA PAIW- IlVeN meets all of the following criteria: • This failed system is connected to a residential dwelling only. Theree are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct deep test holes and percolation tests.at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). 60 .0 B) G.W.Elevation Z3�� +adjustment for high G.W. _ t�o 6 W D BETWEEN A and B l� SIGNED : DATE: Z NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms.are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc i Bk 20159 Ps 179 -0-56814 08-16--2005 a +08:57u DEED RESTRICTION The Barnstable Board of Health has determined that based on State Environmental Code, Title V;310 CMR Section 15.203(2)and 15.214,the following restriction(s): Existing dwelling restricted to 2 Bedrooms be placed on the property located at 23 Pleasant Park Avenue, Hyannis, MA 02601, Assessors Map: 249 Parcel: 139, as property referenced in the Deed File in Book 10090 Page 0026 at the Barnstable County Registry of Deeds, as it deems those restrictions necessary to protect public health and safety and the environment per the State Environmental Code,Title V: 310 CMR Section 15.413 (1). I, C�p�pjll�Y��'3�°e as owner of the property referenced above acknowledge the deed restriction(s)being placed on the property. 1 �P&S wner ignatdre Date The person named above: Uonn QN• M CG Acknowledges the foregoing instnunent to be his/her free act afideed,before me. Notary Public My Commission Expires: Na !th of Massachusetts S. Date 7hen Day appeared the abOMB fl8flled am am—nft . �e m be 1 tee WWI m m BARNSTAL i REGISTRDMORAN P(it W,htt"Pd* A TRU E C�� MY 0ornt> Won �10,2006 FAN MP BARNSTABLE REGISTRY OF DEEDS c ASSESSORS MAP : �`[ { NOTES: 1; 28 � o00pp , TEST HOLE LOGS 1 PARCEL: 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH g Hyannis as it SOIL EVALUATOR :1). Me Q P�_� _ CS E THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF j'rnl� FLOOD ZONE: UIJ ��A'�L� - � �' WITNESS : Nor K-ej�UjP-C10 s7 _ BOARD OF HEALTH REGULATIONS. c�R REFERENCE: �)Y `009 D DATE: Q S1� / �_ 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES eo Q�b PERCOLATION RATE 2Mtw rn�H q / SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO y � Barnstable -""�Ir CLI�SS T ©ll.�j �.-1' '12= C>>7y y y INSTALLATION. � HS w r 3 �� - & S09VP4 j�I( TH- l _�` ,-jQ TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION o, �-G �"�'' V ONLY, AND SHALL NOT BE USED FOR, PROPERTY LINE ,IM DETERMINATION. _ � � �0 ��/ PL.+ of LTV 5 EDwAT-to k �.t 66 �_(,.S �'� S y I �� 20 y G q �. �►NDALL rmmFM �� 1 L�D 1 4) ALL PIPING TO BE 4 SCHEDULE 40 @ 1/8 -1 FOOT. (UNLESS Ilmw L�An�y S SPECIFIED OTHERWISE) LOCATION MAPCtj T.S 16 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A Z4 ) 4-7 j GARBAGE DISPOSAL. 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) C Ca�'RSE � MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON SA 1Jv. A BASE OF 6"OF CRUSHED STONE. 3�►, �� Zo -7.) EXJz717A)4 (E5SP001_ _M 5E PvMySO, Cf-vSkren Pot, Tl i 1-e Y. NO KWVJ k) PIU VA E GVELL5 VJ//N I66/of- P90 f, (,E�t�Wi>�4 SEPT I C SYSTEM DESIGN ��_r�a wE, s w//,U 15o'or FLOW ESTIMATE 10' 0 V kP A-iJ GE`j HOM T�. v 6'p-- hJI�R-NS?79'l3LC giaLT)+ NubkilcfNS 9164vigEY) 3 BED!200MS AT I�d GAL/DAY/BEDROOM - �GAL/DAY Ii� Sl. �/E 4" PU c. l0 E ►�t ESL-- SI nE OF H2D tiNe IA)l Z 6R. fi{TL�A-L-/3 SJCDESK N /2 8 DEED . C I�IP� SEi�L. i b5 p►� (o�' G). -- SEPTIC .TANK t �Z. IST I� UI�.��D) PV �j�GAL/DAY x 2 DAYS - emu GAL USE / ��D GALLON SEPT I C TANK ,_ AjEk) BENCH MARK SOIL ABSORPTION SYSTEM BASEMENT SLAB , ELEVATION 50.83 50 ) �t��t1-r. � -.�D2O ��w�n till 33 S1aNE of s, '.. .+.� • .�� T..p L , mom` !} a .}, Bf\RI�lS I f�I�LE vPa D � � ))//���� r ) iJ}i �/v ;�, .;",,� -, „ { 155 00 {t / 1 SIDE AREA:� `o Zt.. 2 � . (12.1/,) Z�x 2- X o.74- = 110 O EYER 1 m Na & 2 X )TTOM AREA: 5 12 X-16 0,7+ = -ZZ� , . 1140 ` �� 1S �a t� � TERN C(l4M S-- --�-- N17AR\P Vd" n j G S , . GITE 1-----, 7 3 30 G P� rP c/ rn 1AVER pRIVEwAY SEPTIC SYSTEM SECTION o UNP z - 0 ' STING Z° '/ A7ER LINE 1 70T- - EL, SO`$3 E X I L IN G � ; sue"` _--'" -- W EOF SLAB 1 ENE �` 1 —� �t4 N Cove-ie S Tb VU/ N 9rMn► TOP 5O $3 �l PS L ;, 1 m� 1'�eSe �� �O a� �415� /"acc "M� �„� ' 54 EL -o G I {t > 10 llt J� X w�'"G AnIS43-otck 71 6l I"S II p2S 4S &+file e o c \ . . D-BOA 47, 83 o \ 1 < J GAL 48.° Qvil W t i —•, Ttl •' • • • • a • • • • m SEPTIC TANK �CVc//1?SS 7,A7 �' EL_yS5 \ ) # \ 0 T 3—A AREA 14725 s f + Z5' ' 1 � ��N� C/f�s G77&,A/ (o.� I � ' \ SHED 1 TTb or- 7FS7rfo GE Na 'os2 2 t,�,+, Double h" SITE AND SEWAGE PLAN 00 100. so ti /+"-�iu L 0 C A T 10N : 23 PL.EkS PftRI�. �V PLAN56 54 52 DDUy�e �"��{ 1J)S /'1�" Dec b 0 SCALE: 1 in = 20 Ft n — 4a, �" 48" vJaSkec� PREPARED FOR : I f2 dta W DARREN M. MEYER, R.S. SCALE. _ 0 Z P.O. BOX 981 DATE: 2► Z EAST SANDWICH, MA 02537 W 3 DATE HEALTH AGENT Ph: (508) 362-2922 Z I I I . i — ----