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Home My WebLink About0464 SCUDDER AVENUE - Health .. 464,Scudder Avenue Hyannis A=288'-007 fft� i 11 q 9 c, TOWN OF BAFNSTABLE r 7 t-� LOCATION SEWAGE #�ilr✓I1C1�.J�C� rt^ VII;LAGEi YI ASSESSOR'S MAP & LO INSTALLER'S AME&PHONE NOlf°I L�VGSIQf�®/ S 569 M SEPTIC TANK.CAPACITY o er. LEACHING FACII.ITY: (type) (size) NO,OF BEDROOMS f7LeJ Dr&;e-) Kli s BUILDER OR OWNER -r-61 LICY PERMIT DATE: Ln COMPLIANCE DATE: . 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 ANT -a. � C9 � = Af ar,3 3 -3519 ell" ®, •7 V_ . Town o Barnstable ` - P# N 3 c - �y�' '� Department of Regulatory Services / Public Health Division Date rages s63p. � 200 Main Street,Hyannis.MA 02601Ai ' Fo tom" Date Scheduled � Time Fee Pd.- 6 �� Soil Suitability Assessment for Sewage Dis osal Performed By: � � � Witnessed By. LOCATION&GENERAL INFORMATION Location Address 1164 &a4 `_e- Owner's Name ;o�i Luce (��,�.. �Address Assessor's Map/Parcel:] p ®®.� Engineer's Name NEW CONSTRUCTION ®REPAIR Telephone ) . Land Use &-c"04"L i..w Slopes(45) Surface Stones Distances from: Open Water.Body#Z ft Possible Wet Area 0 O ft Drinking Water Well _7_t.Pft Drainage Way 3 S ft Property line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) gc /4J W �M cza CIO ®TP { k k'•� ^tr C,f i �k. Parent material(geologic) y I0 f� wV Depth to Bedrock z I7z /6 a Depth to Groundwater: Standing Water in Hole: �p� Weeping fl'om Pit Pace E4 •93.3 Estimated Seasonal High Groundwater ,L�. 7 3• DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: _ Depth Observed st nding in obs.hole: _ __W In. Depth to soil mottles: J in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment 6. 2 e, ,.ft. Index Well#A1}u( Reading Date: ♦ /—. Index Well level Adj.factor Adj.flroundwater level �f L PERCOLATION TEST Date �. Time-L&404 Observation 'Hole# Time at 9" 'b,y9 Depth of Perc I z,• Time at 6" �0 Start Pre-soak Time @ Q — 'time(9"-6') End Pre-soak Rate Min./Inch LZ Site Suitability Assessment Site Passed _ Sitc Failed: Additional Testing Needed(Y/N) . 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 Conseiiwation Division at least one(1)week prior to beginning. Q:ISEPT0PERCFORM.DOC c^C DEEP.OBOF SERVATIONROLE LOG Hole y / ry��} Depth from Soil Horizon e# Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders. O. M r•I I n i ten vel - shy A L•S. ioYn%z DEEP OBSERVATION HOLE LOGfiHole Depth from Soil Horizon Soil Texture Surface(in.) • Soil Color (USDA) (Mansell) s. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Surface(in.) (USDA) Soil Color , Soil Othe r Mu( nsell Mottling (Structure,Stones,Boulders. Co itoc O vl ti Depth front DEEP OBSERVATION HOLE LOG Hole# Soil Horizon Soil Texture Surface(in.) Soil Color Soil Other (USDA) (Mansell) Mottling (Structure,Stones;Boulders, Consi e Flood Insurance Rate Mae: Above 500 year flood boundary No X Yes .--__-- Within 500 year boundary ` No Yes, within loo year flood boundary No JE yes . Depth of Naturally.Uccurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all amasfobseryed throughout the area proposed for the soil'absorption system? If not,what is the depth of naturally. y pervious material? Certification I certify that on12.5 (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 tra'ning,a pertise and experience described in 3 10 CMR 15.017. Signature Date Q.%$EPTlMERCFORM.DOC TOWN OF BARNSTABLE LOCiATI m �. SEWAGE #� ,.� -- VILLAGC uuvt,� dam' ASSESSOR'S MAP & LOT I� ' INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY .j5:67p c3 c4-C�r —CIA LEACHING PACILITY:(type) O,&kV5- (size) NO. OF BEDROOMS PRIVATE WELL PUBLIC WR ��i' BUILDER OR OWNER . I DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No_ ��____ ' � I O , 1 • J \ Jh Fss...... 7.. D� THE COMMONWEALTH'OF MASSACHUSETTS BOARD OF HEALTH 4pliratiun for Disposal Works Tonstrnr#iun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ....��4. .___��__'. :4?. .....e`{z•-.....a -:.................... ...•------. `z:!ti'1t5:� ._.:....._...---- - .._..--- . .-Location-Address - or Lot No. ._._ Owner Address I ............................ ..:�.§I.. ....... `�.2..:.......:.. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms...=4..................................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Buildin ........... No. of persons............................ Showers g`--•--......--•--- P ( ) — Cafeteria ( ) dOther fi'Atures ---------------------------------------------•------......----.....---•---•--------•---....---..........---•----------.......-•-............•--........ W Design Flow......a................................gallons per person per day. Total daily flow__....S-UZ)_......................gallons. c� Septic Tank.- Liquid capacity_l - allons Length...1.t.`..... Width.. Diameter................ Depth................ W x Disposal Trench—No... ...p �FJ��S. Width...... Total Length...P_A�...__. Total leaching area..................sq. ft. Seepage Pit No..:.................. Diameter.................... Depth below inlet....................Total leaching area..................sq. ft. Z (Aker-Distribution box Dosing tank ( ) •.' Percolation Test Results Performed by.......................................................................... Date.................................... :.... a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-._-----------_-.-_..__. f: Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ x ................................................:.................................................-.......................................... 0 Description of Soil......................................................................................................................................................................... V . .............................................. ----.•...........-•------........---------.....-•--•----•-------•......---•----...-•---•--•----•-------:....----------•-............--•....--•••••..... W U Nature of Repairs or Alterations—Answer w en applicable_ ��.... . za.... ....... >.i �-1.�. -...u t.�_a.. dv-.. ..................... ------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi LE 5 of the State Sanitary .Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by.the board of he lth. Date Application Approved BY a�.....�--� ...............•---------- --•---... J Date Application Disapproved for the following reasons:------•--------------------•-----•---------------------•-----------•------•-----•-•-••--•----•-..........-------- --------•----•---•-•----........._----------------------------------•--------------------------•----------•----••--•-••......... Date PermitNo....... ._1'.!? ------------------------- IssuecL........................................................ Date .. ., . .. ",� •�� -""• 3-0�� r,....,� ...d.�.. ,.�.• .x AIL a. .'.a. r .)1'r�� -.. «- .. .a _��.,-.,r�l.Iw} Pfrl�-,+,y., � i D� THE COMMONWEALTH OF MASSACHUSETTS f/ t BOARD OF HEALTH ...................... ........OF... .. �C.1R.S� Q .. Appliration for Utopooal Works Tonotrurtion "Prrntit Application is hereby made for a Permit to Construcfl(� ) or Repair ( ) an Individual Sewage Disposal System at: t ,A n n . ,, l ..--•-------...______........................ ,._........_. .•--•--........-•--•••-•-•••.........---••--.......---•--•• Location-Address ( i\ or Lot No. `11 . r' _L t S...:e......................................... '"y( `.�. ........)c�l c.ore lot i!v" �.......................... Owner Address a -- ---A•!>L�P S��--c� l f>4z_�._�..11�...4 � :....�Z�C �=./I!U_��S............. .. ..... Installer Address Type of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms.....4...................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building W yp g ............................ No. of persons............................ Showers ( ) — Cafeteria ( )a dOther fixtures .--•-•---•-----...--•--•-•--••-•---••-----------------..........--•-----------...--•---•-••--••------••-----------------.....---...-•---•--•---..•---• W Design Flow.....:.- :. ............................gallons per person per day. Total daily flow----- ................gallons. Septic Tank--Liquid ca.pacity.L�: allons Length._11)....... Width.. `....... Diameter................ Depth................ Disposal Trench-No. q e4liSk s. Width.....�'............ Total Length_._-)_.n-'...... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter....._.............. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (L-),-' Dosing tank ( ) Percolation Test Results Performed by,......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ts, Test Pit No. 2................minutes per inch Depth of Test Pit__ ................ Depth to ground water........................ 04 •---•---------------..........................---------........._.........._.............---............................................................... `0 Description of Soil........................................=..........................................a-------------------------------------------=......................................... W -----------------•............... - --------------------------- ----------------.--........----------------- .... x ------------•• . •••-•-----•--•-••--••-----•--••-•-•--•-•-------•--•••••-•-....-----••---•---•-•-•---• •---•• -•••-•-------•--...--•-•----•-• •------•-----------•--..... U Nature of Repairs or Alterations—Answer when applicable-7.T_*� AN....t'S�_.�v��`� ��t;ti�.__...... � r---------------------------..................................... Agreement: TIVe undersigned agrees to install the aforedescribed_ Individual Sewage Disposal System in accordance with A L `the`proision i of TITI.- 5 of the'State Sanitary Code'—:The-undetsigned`�further agrees:not to place the system in ' f operation, nt 1 a Certittcate'of:Compliance 'has,been,issued by the.boald..of he`a�lth�., ti g Date ' '.:'- Application Approved By' t �'''�''��y ........................................��- ' """ ' •..............J t Date Application Disapproved for.the following.reasons:.............. ` W I ..........................................................................�....................._........._...................................._......__._.............................................. x Date Permit No.----- !_..=...� �a....... ........... Issued...............•--------•---•--•---••-•----••••......... I r r Date { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .. CIrrtifiratle of Tomphatt r THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired,( b ►/�_ _ h ►4_K: - ,"'�`-=t.........................................................................................•------...... y....................••- ---....._._.-..•- - lnstaller at................ ( �. t tck�. r t�- ..................... d�T� --V----------------------------------------------------------------•-----•--..._ has been installed in accordance with the provisions of TIT 7 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit �'o.............. .....c� �CIG' dated_... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. 1 _I -_ inspe ctor� .... .. -- .�--------------------••--•---.....----•----•--....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -7 t c!. ';.......OF...E.Kuz..- l....tl.A.b h�..........--•............................ F/ No........ �-_ b/ FEE........................ Disposal Works Tonotrurtion "remit Permission is hereby granted........ ....e_^ r -- -••-••---•--•--•-•-•-••--•------•---.....-•••--•......--•-••-----•......--••..... to Construct ( ) or Repair (;-.-)-an Individual Sewage Disposal System at No.............. k( _j.... :C 0 A ,, .4-�, d <d��..-------- -----•-- . ... Street c, as shown on the application for Disposal Works Construction Permit NO----- \6_-Dated.......................................... r d/ a Board of Health DATE................. _ -�"-�r S