HomeMy WebLinkAbout0018 PLYMOUTH AVENUE - Health 18 Plymouth'Avenue`` `
Hyannis
A = 310 001
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TOWN OF BARNSTABLE
LOCATION. �(► > Ave SEWAGE J006�D3tg
VILLAGE N- -ANNI" ASSESSOR'S MAP&PARCEL _3j 0 ®0
INSTALLERS NAME&PHONE NO. ?ob`W Soc&) S frFrc Sdy- 7:25-21-7
SEPTIC TANK CAPACITY Sep®
LEACHING FACILITY:(type) .a-$®o
NO. OF BEDROOMS o� a„ tee,,,, U Je Z(L sl iilo L
OWNER Cik)7N 1c CAU X-t( + fl CIN8!k c1(Z6
PERMIT DATE: S COMPLIANCE DATE: S I
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
'10
r.,
. Y
c;b co
N
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Rppricatiou for �Digo!ml *p5tem Cou9tructiou Permit
Application for a Permit to Construct( ) Repair)( Upgrade( ) Abandon*( ) X Complete System ❑Individual Components
Location Address or Lot No. %W P/ jv?j)u jk i og 1A O er's ame Addre s,and el.No. 5C6'77 1 RY 3'
Assessor's Map/Parcel C 18, -PL*WI ou Tl{ A V G PyAno'IS o2 ba /
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 1(/ 7z0 sq. ft. Garbage Grinder
Other Type of Building No.of Persons 21 Showers(f ) Cafeteria( )
Other Fixtures
Design Flow(mi .required) gpd Design flow provided gpd
Plan Date �' i�,3 Number of sheets Revision Date
Title
Size of Septic Tank S 0 O 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 a d not to place the system in operation until a Certificate of
Compliance has been issued by this B�-ofaltFA
Sig a Date J o
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. "� Date Issued
yam" 4+ No. Fee 60
r THE COMMONWEALTHOF MASSACHUSETTS Entered in computer:
PUBLIC HEALTHDIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
,. � e
y
, ptication for aigoat �§Pztemc Con5truction Permit
Application for a Permit to Construct(" j Repair Upgrade( ) Abandon(( Xcomplete System ❑Individual Components
Location Address or Lot No. �� f� �O�f h ) �A 0 er's a e dreg,,and el.No. S -?�1-9 37
Assessor's Map/Parcel � L
>='104-
18 )'v�ouTi( /��C NyAoifS v26oi
Installer's Name,bAdldlress,and Tel.No. ry"�} Designer's N me,Address and Tell..No.
V R4 04W
,Type of Building:
Dwelling No,of Bedrooms , 21 Lot Size �4 7Z? sq.ft. Garbage Grinder A
Other Type of Building 7prL No.of Persons Showers(� ) Cafeteria( )
-N.
Other Fixtures
Design Flow(mi .required) gpd Design flow provided gpd
Plan Date 3 a3 Number of sheets / Revision Date
Title
Size of Septic Tank - 1�S 0 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 got to place the system in operation until a Certificate of
Compliance has been issued by this Board of alt
Signed o Date
Application Approved by ,• _ O _ Date
Application Disapproved by: v o Date
for the following reasons
i Perm t N o. Date Issued
—=------ --'—=�------ ---=— --- ,
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed'( ) Repaired ( ) Upgraded ( )
4 �
Abandoned( )by
at has beeen�c n tructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. (/ ) '"t dated
Installer 'Cc 40 Designer
.9bedrooms - Approved design flor "2 '�_ r" gpd
The issuance of this p rmit shall not be construed as a guarantee that the system function as desig, d.
Date ��p Inspector l r'`�kllvv.
NO. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
Digogat i§P5tem Co 5truction Permit
Permission is hereby gr ted Con truct ( ). Re air Z ) U, rade/( NJy
Abandon ( )
AA
System located at 0( a , �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: o truction must be completed within three years of the date of thi�pit.
�._. o.
Date Approved by
F1HE Town of Barnstable
� r
Regulatory Services
Thomas F. Geiler, Director
• BARNSTABLE,
MASS.039Public Health Division
v 363
�AIED'i1P�A Thomas McKean, Director
200 Main Street, Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
- Installer & Designer Certification Form
Date: ��� (�-0 Sewage Permit# O( Assessor's Map\Parcel
Designer: Stetson Hall Installer: Wm E Robinson Sr Septic
Address: 28 Rambler Road Address: PO Box 1089
Osterville Centerville
- On Wm E Robinson Sr Sep4gs issued a permit to install a
(date) (installer)
septic system at 18 Plymouth Ave, Hyannis based on a design drawn by
(address)
Stetson Hall dated D(o
(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.
STEMON
. ' OF
*( esi
r'st'Signature) R.
& No.5HALL6
27 O
EDSer' i e) (Affix Desi_ p 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: Health/Septic/Designer Certification Form 3-26-04.doc
'Town of Barnstable P# v .1
Department of Regulatory Services
Public Health Division Date 1111v,)2
200 Main Street,Hyannis MA 02601
• BMWSTABL&
MAM
ArEo t►��� Date Scheduled o_ 0 3 U Z Time V0 U M Fee Pd.
Soil Suitability Assessment for Sewage Disposal
Performed By:�J%i Fr1� J- IR Witnessed
Location Address Q / /� Owner's Name C0 f ce-r�� U -� cl-I-
J�jGp ( Aoro-C CA'L�r✓FLL
Address
��r✓r✓I 1. f� IYOOJ�
Assessor's Map/Parcel: 31L) ' �U) Engineer's
NEW CONSTRUCTION REPAIR Telephone# -6-0
Land Use F Slopes(°/.) L / _ Surface Stones 6Z&*V-0
Distances from: Open Water Body ZIA O ft Possible Wet Area,?e?�10_6 ft Drinking Water Wellt/aarJ ft
Drainage Way ;;'/OD ft Property Line ,?0 ' ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes)
no
t
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Parent material(geologic 00;;/I 1X11-7f,Aiiv Depth to Bedrock �S� -�
�r l�•c�T3' P g r✓c Nis
Depth to Groundwater: Standing Water in Hole: /��(P Jc__1 Wee in from Pit Face
Estimated Seasonal High Groundwater
' TTI( i li' AC►11 HIT' N.T' R8
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 Adj.factor Adj.Groundwater Level—
' 1C3LA'�I( N TT
„.
Ua# Trml ..
Observation Time at 9"
Hole# r.w
Depth of Perc
/e�'/ �o� � Time at 6"
�--
Start Pre-soak Time @ /0:6 Time(9"-6")
End Pre-soak f O, /0 4,01
Rate Min./Inch ^�
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
Q:HEALTH/WP/PERCFORM
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in. (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency o l
01
• - D q_ it C y �� 714
p��P QB�ERVA�'I�N HC?�tE LAG Ha e
Depth from Soil Horizon .Sol1 Texture.- Soil Color Soil Other _
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
0
.... .. ......
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
SK
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency.%Gravel)
Flood Insurance Rate Mangy /
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 pervio s 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 // (date)I have passed the soil evaluator examination approved by the
Department of Enviro mental Protection and that the above analysis was performed by me consistent with
the required tr ' i g,a ise an perience described in 310 CMR 15.017.
Signa Date 3
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As sDEEP OBSERVA T/ON HOLE L-_ C
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CONCRETE c COVERSAIAJW
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.. 4 CAST IRON
R SCHEDULE'40 4 _ R R. 0 SCHEDULE 40 P.V.C. (ONLY 9 MIN , LEACHING TENCH ( ) EO
►.. P,V.0 PIPE MIN. PIPE-MIN. 1/8"_ 1/2" WASHED STONE 36 MAX.
:PITCH 1I4 PER.FT .FT. -
PITCH I/4 P� 6` ,.../y
INVERT GAS BAFFLE- � INVERT " ' 24
INVERT / 6' 0 � _. r .Q;;A �.i CI�:Q,'l=t,'/>�a Q;'f.,]�-
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SEPTIC TANK
�j EL_�__yd
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� .INVERT 4 INVERT
4. GAL.: INVERT 'di ST, :.
EL....�,1..... Precast 500Ga1.Lea Ch 3/4,._1V2„-/
BOX EL-._Z (a) REO.
6"CRUSHED STONE Chamber WASHED STONE
_ .
C ROFi LE OF rr -r a le -
b GROUND WAIZR TAdL'c �✓c
O— 37/. SEWAGE DISPOSAL SYSTEM
SOIL LOG TYPICAL CROSS SECTION
i /ca NO SCALE LEACHING _TRENCH
'
DATE1 � t Alt TIME . 4. NO s: L-
-EST ,ROLE I TEST HOLE 2
� DESIGN DATA
7. 9. MIN.
_ µ-SHED 36 MAX. ;
i /' sy�Gd�I/►'7 N'UIMSER 0- °_.,ROOMS ='. .p �!r ✓gyp - , . . S DNc
�// - 211
?�� Ly I TOTAL ESTIMATE-) FLOW .. .--33c� . .. GALLONS/DAY _ _ 8l,
8
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Cow r� .1ia„/� y1 BOTTOM L=4C"IVG AREA . O.r�. T'ENCi
........... S 24S1 TE PLAN 18 PLYA40Ll TH AVE HYANNIS9 ✓ A SIDE LEACHING AREA SO.^T./TRENCHc
GAR°AGE DISPOSAL . . !!/Q . ..(50°o AREA INCREASE)
TOTAL LEACHING . .. � �'�.: SO.;T.
4n/�)/1.�' G�Lv�✓�.LL dc•- //?i�s/��L w,�b�,�'Q � � . �.��✓.� P46
-RCOLATION RATE ' ' ✓/ Gf� P_.4. I Nc + i re
•CACHING ARE PER PERCOLATION P.T ` rr-'�. So I . r N
zG e7,/�! OIo6 GROUND WATER T..SLE �-�
APPROVED�_ ^0 0 Li H
ELF / - � ��i✓r/11�� � � � ;��� �� � � _. ENCOUNTERED DATE .. . . . . . . . . . . . . . .. .. . . . . . . . . . � M ssgc
AGENT OR INsP_•�TOR �
E Al/',
WITNESSED BY
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