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HomeMy WebLinkAbout0164 SIXTH AVENUE (HYANNIS) - Health 164 Sixth Avenue Hyannis r, A=,245 —`098 - UO2xfi=, s 1 r G UPC 17734 No�y53CR °p57-CONSJ��� HASTINGS,MN i { � � �� 1 �. _.� ., a �, � 1 ,, � . TOWN OF BARNSTABLE �` LOCATION A/dZ SEWAGE# O 6 VILLAGE ASSESSOR'S MAP&PARCEL DIN�T�pLERTE&PHONE NO. 7? .:•2/3 Z "4 r9�r J'r ,x ' S Oa/ /,.fi✓ SEPTIC TANK CAPACITY /ram LEACHING FACILITY:(type) -i'✓✓fil l r®Ja P.J" h" (size) Y3 NO. OF BEDROOMS OWNER. l✓ !'� !/S. PERMIT DATE: oI 9 d 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 �t on site or within 200 feet of leaching facility) qlo Wig>b . feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leachingfacility). /�O w�. ty)• eet� i • yy FURNISHED BY y' 0 � ' P! b THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: �/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for aigonl i§pztem construction permit Application for a Permit to Construct( ) Repair W<Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. k b'( S YX76\ O V t­ Owner's Nam ,Address,and Tel.N . L -).l'lyQ-e,(\.sfoo,FT Assessor's Map/Parcel .74 S O9$/Od a 77S'o�p7'6 Installer's Name,Address,and Tel.No. W",J n Designer's Name,Address and Tel.No. ec :std $08-4(3e - sod , 36a- os Vc itl 0 6ss SSaS '�- - A hA . a 01aa Type of Building: Dwelling No.of Bedrooms `y Lot Size DoD sq.ft. Garbage Grinder ( �)0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) 7 y� gpd Design flow provided 4/�� 3 gpd Plan Date — 1`06 Number of sheets Revision Date Title / Size of Septic Tank /c5 00' GA/. Type of S.A.S. r4 T�1%r9 70P_S Description of Soil 41 DC-,6 A4 Nature of/Repairs or Alterations(Answer when applicable) Zm t 9',% (CSl 00% n /.5b0 6,9 7 yTig?2S i:j s� �3 'X 9 mac% 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 i bythis Board of H Ith. Signed Date l 02 06 Application Approved Date Application Disapproved by: Date for the following reasons On Permit No. v \ Date Issued J ,.� •,v i"bF ` -� �-.-.. _!.. +�� ,p,.9,ygPr fpb'a.l"`.i :..+.• �#��� . _�� J'."�y..-•,.., .«• t , V b t Y r 6 Fee Entered in computer: '=--TlrIE COMMONWEALTH OF MASSACHUSETTS` Yes ��. p PUBLI'(CHEALTH;.,DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ._ application for Migoogal �&pgtemc Cow6truction Permit Application fora Permit to Construct( ) Repair(Upgrade( ) , Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. b�l 5 k i 1\ 1'I V p Owner's Name,Address,and Tel.No. ` I 11r\ � �� �\ �`iA\_) / 11P1r) lV�1CL Jog Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r ccicv� �13N� �carrc� � cf 5u� 3�a' e_•v,Z.Uk Type of Building: Dwelling No.of Bedrooms Ll Lot Size 9,Gw0 sq.ft. Garbage Grinder Other: Type of Building No.of Persons Showers( )' Cafeteria( ) Other Fixtures-, Design Flown.required) ���/O gpd Design flow provided L/ /0' 3 y gpd Plan Date Number'06 Number of sheets / Revision Date -Title _ Size of Septic Tank /S-0 O G Type {•/761/0,a • � T e of S.A.S. .Z;i P S Description of Soil Al ,(fie- ,0 IM r r .. Nature of Repairs or Alterations(Answer when applicable) 1U%»e t t P'll a-s 1 poo l- j/r/� /5'y u Gn/ 7.},,X• I lei A 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 e lth. 1/ 1 Signed Ci "'�" 1/ Date Application Approved — Date O Application Disapproved by: Date for the following reasons P Q' a Ji I Permit No. ©� t'C "`� Date Issued / to THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired K-5- Upgraded ( ) Abandoned( )by --`J^ �`�'�'e r' C y r�S (J.7.✓tLr Sl�"rP^�w� at �6u( S X�� �'` 0.nr�c r has been constructedpin accordance Q with the provisions of Title 5 and the for Disposal System Construction Permit No. dated (` P P Y Installer,;Zr rc�� - r..r Wjnd6n ,STr'AADesigner #bedrooms 4 Approved design flow e/ gpd The issuance oftt,is permit shall not be construed as a guarantee that the system will-function as design td. Date t 1 � (0�} Inspector ��}}/—tom--�— —— —— .. No.l.7�6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 1ig000l �&pgtem o gtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at t-��c-n�� s 6")r-7 and as described in the above Application for Disposal System Constriction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions., Provided: Construction must The completed within three years of the dtate of this permi . Date_ (� /tP Approvedb.by�„1 I Town of B rnstable. P# 6 �t+E � Department of Regulatory Services Public Health Division Date •e v �a'r 200 Main Street,Hyannis MA 02601 �rfD trtA'i« '• �V Date Scheduled � :Time Fee Pd , i • i Soil' Suit bility Assessment for S a e Disp C k3 Performed By. Witnessed By: i LOCATION & GENERAL INFORMATION Location Address �j j�-r j4 )A;�V F V Owner's Name H7kRpy 1nl 6L&tj . K}/A-?-J rJ IS PO IZ�T'. ' Address f o e)0V_ Assessor's Map/Parcel:Af S /®jS l�0 2_ Engineer's Name DI 11 �_a> 2q� Z NEW CONSTRU�'I;ION REPAIR � I Telephone# J�'bYj ,gyp 12 Land Use /\'H/ t (/�✓� vV/ Slopes Surface Stones Distances from: Open Water Body. 7 ft Passible Wee Area 7 Z�ft Drinking Water Well `✓" ft i r Drainage Way > ft. Property Line > 16 ft Other ft SKETCH:($treet name,dimensioris'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 6E k1l J�.�b �C� l0>S• � , i I - Parent material(geologic) i Depth t0 Bedrock Depth to Groundwater. Standing Water in Hole:' f'1 i Weeping from Pit Face Estimated Seasonal Nigh Groundwater i DtTERMINATION FOR SEASONAL HIGH'WATER TAB Z Method Used: Depth d;erved standing in obs.hole: in. Depth to s011 mottl9s: Ins Depth toiweeping from side of obs.hole: ! in. Oiaundwnter AdJurttment Index Well# Reading Date Index Well taut l ! Adj,factor� Adj,Groundwater Level.,,,,m, PERCOLATION TEST Daft: Time /-�+�9 -• Observation I Tune at V 9 Note# e� s/ a yy LZ Depth of Pere '7 y y"/J Time at Start Pre-soak Time.@ `j Time(9"•6") ; End Pre-soak 0 Rate MinJinch Site Failed: Additional Testing Needed(YIN) Site Suitability Asse$smeat: Site Passed._.rs.._ OriginaL•.Public H41th Division Observation Hole Data To Be Completed on Back--- ***If percolaii(in test is to be conducted within 100' of wetland,you must first notify the RornctahlP.(''Aiiservation Division at least one(1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsis enc Gravel ! 3L �IW J 8 36 H 173 Z,�Y/S LE LOG Hole# DEEP OBSERVATION HOLE Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface fin.) (USDA) (Munsell) \Mottling (Structure,Stones,Boulders. nsis enc %Gravel) l,oaM SaN41 /o/it¢/v N � I1�3� L3 joM ,Sah p f -M1eS� Z, r/ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsiste c Gravel /on v 251:IZOk DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. e n ist d'' j �� a�f �� 4 v a 1 J .- 3o Q ti M n •• U l� 1V h Zb" (. . vl^t G dJ Z. 1�3 Flood Insurance Rate May: Above 500 year flood boundary No_ Yes Within 500 year boundary No X Yes Within 100 year flood boundary No Yes Death 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 pe vrous material?y:__ Certification I certify that on V (date)I have passed the soil evaluator examination approved by the Department of Envi onmental Protection and that the above analysis was performed by me consistent with the required ing,expertise and experience described in M CMR 15.017. Signature G r'` Date 611 Q:ISEPTIC\PERCFORM.DOC Oct 12 08 08: 36p Darren Meyer, R. S. 17815850293 p. 2 dt Town of Barnstable d'WE Q. Regulatory Services Thomas F. Geiler,Director • unnrsteBLL M.f g Public Health Division rbso .e Thomas McKean, Director 200 Main Street,Hyannis,NMA 02601 Office: 503-3624644 Fax: 503-i 90-6304 Installer & Designer Certification Form Date: w LSewage Permit# Assessor's 1laplParcel Designer: �� Y/P✓� �J 1Me yam✓ Installer: f►�Si►�r _ �' S (�wl Address: X g� Address: r T Sfwy w icH MA O2-53 krmo Z� M� , On a�r 6 W'N`��"� ' S ^0'/� was issued a permit to install a (installer) (date) septic system at 104 SlYMI AV61JUEO 4 y""J ►SKLed on a design drawn by (address) :D�Yfel\ t4. Wle yer dated (designer) X I certtfv that the septic system referenced above was installed substantially accordins to the design, which may include minor approved changes such as lateral relocation orthe 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 certifie as-built by designer to follow. Of ,IGs�'c DARREN. M. y � MEYER -� (Installer's Signature) 3, No.' 1140 H v SIN I TAIL% (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO SARNSTABLE 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: Heahh/SepticMesigner Certification Form 3-26-adoc KLINE �6 cc At N rl CON. A ION 1 i ililii MA Lfp �.; c assEssoRs MAP : TEST HOLE �� PARCEL : MhP A FLOOD ZONE : NUIJ t jA2 SOIL EVALUATOR : D. REFERENCE : WITNESS : Dore 0E,M i DATE : Tu 2j 20C26 PERCOLATION RATE:- aS .Z �0 U - _`. ?Fhl(r1r oil TH- I LoAm 'LOT/ - .- -- .. .�. L.��U�.�Vet ,1._S i SIT 3 LOCAT I ON MAP (t4,r•5 S � INN' 1 �►v P-1 q SAD 7% 2• 'Y 3 125�1 No 64A) P-Vei SEPTIC FLOW EST1 BEDR01 Z F5f- R SEPTIC TA 80.00 FL AL/ Ln USE Lo CESSp�I I` SOIL ABSO qN I STG7VC O) I L 1 II I SIDI k-L W BOT EXISTING I �, -41 DWELLING � I I � SEPTIC I TOP OF FNDN EL = 15.77+- I Tor = EL IS•7 oco�o les zU • N V / �. t c l0 Ft z z Lij J -}- l 1 ?� TN�3- `�lo�M►a�� t't = U U LL < 10 F F41->- z > (!) 3 I I a_ F ---,.- m -�.z_ TW-4 L:)!�ols \(Y) 80.00 FL Q CY y Ln �ti r EDGE DF PAVEMENT SIXTH AIVENUE OF RAI d D .RREN I 1 L } I o. 114` �FGISTEa�O s'9NITARI I, D G S () Tl1 EG 14 �{I NOTES: A U'SyD f0y2'�f�,, c �- CZ S CSC l0 13.58 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH THIS PLAN, 1995 MASSACHUSETTS TITLE V & TOWN OF ZQu Sk�MI� 12 a �] fi.CAI BOARD OF HEALTH REGULATIONS. -2 Mi�„ I�� f l NE— � 2) THE `INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, f AlyEn Iv�1 1p I SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO f LFA 2 O,7tf 9 P4 I/ ( n wr 7 INSTALLATION. '" 0 TH-2 EL= I?�•�S " 2'� 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE _26 I �..�y DETERMINATION. 0 - EL .y' 4) ALL PIPING TO BE 4" SCHEDULE 40 ���My o �� SPECIFIED OTHERWISE) @ 1is "� FOOT' (UNLESS A S�m►'o II,� � 5+�� I y fy 2q 13 ` 5) THE DESIGN OF THUS SYSTEM DOES NOT ALLOW FOR THE USE OF A �vAM� (p��S/ GARBAGE DISPOSAL. 30 11170 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) ry _ MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON fl � `I7/ G iJl A BASE OF 6"OF CRUSHED STONE. u � 25Y7/ �o 6 w p JAJ D 00 6 w o�- �l L:t,4 .- 7p ...Fel. - TTI TA N/. Rv PuVATI weLt,.o!� wild 1 yb' or ► AO STEM DESIGN 1 r10 W6TL-PftS wJ1� I SO 10 P TE o°Ca-1 A 4`7 �WM T1 TLEV OYL 7VK,N F &n4,5, f 3 AT . I10 GAL/DAY/BEDROOM -440 GAL/DAY :• d I-} Prt�1�-� fZC�Vt.�t-i tQ t,�:c� V I YL . 4 GvL PpvposE;�; 11. - NonL' ,.v r ccRf `jY x 2 DAYS - y. GAL 12• P�u►v4 , 7b { _ �bc —� ...7v_. wrT..OI i ALLON SEPTIC TANK — - 7 .fie_ rZr� Lb C o}_ .7v �� . _LU._. :. TION SYSTEM ,r fv1�rv)�v„vl... �5 1N 1 ►L "C"� A 7Z�2 uIV I T-S vjl 2.q?_ F-r i tl•�:.. ` .C> j= r :[ c� U N �'r+ y J L JC X.G I- 1 1((1�S60vt5 A 1-C'A [ %R.EA: I(��} z �-C�}2�x2. x a , 7 � `; is3,97, .4 AREA-. ./�3 x ` -x - _ ZS� 3g S TEM SECT I ON ' � ° G P � o il ^ 13P-1 ni�0I'of �ih i$1 �✓At [ 911A --p-------,�--•- 4w- SfQ foPlt'l'sk1�9.R -a 13CAAA-X � �...._ GQs gq lP 1zv2- tDW D-BOX g 3 L `2 pU I� . SEPTIC K -El . -f 1.NG� o NastieW S ITE AND . S E WAGE PLAN LOCATION : l b� 5/} TH A-vi��JUC Z rr I, z� I' — Wa s G1 P. PREPARED FOR o F 77s_ 2-87-6 Ioa DARREN M. MEYER, R.S. SCALE : I � P.O. BOX.981 DATE : 8 �� EAST SANDWICH, MA 02537 PATE HEALTH AGENT Ph: (508) 362-2922 60q � � _.....L_.. Ora - f --- __ I r -r -- i----- � - _1 J_ _. � l _ I I .I i I I ► ! I I ! I i I i I J I I _ , r ____�-.- -� ---- ---- _____.l___-L_T_�.__. 1_. ._ I. I r 1 o . WAM --- ti 6th , VrYuf-- �iV �4 ��1?'iRV 1 • SCALE: ./.rO , APPROVED BY: DRAWN BY j4WAjQ 1' DATE: TAN 09 REVISED I ! ' DRAWING NUMBER 5L vA-T/D"k! 4,_4�� o � in 3 l 0 10, 4,-3^ y_ror, a , M I IT t off 0/f MN � t M N N � 51-Orr 5'—/!" 3'-4" - q II-6n 9-7"' I O Z�° 4/" IT 10 164 6t� AvvvF AovM -A6 44?�6 OSCALE: O APPROVED BY: - DRAWN BYv�O . � 2 DATE: �I ' 7 REVISED 1n N � Mi Kvs 1a_o AW*TiA(4 . p DRAWING NUMBER e TO-— '— 0°G# CowmrE w�1u I i I bROSF i I I � on I. 1 �ouNDt'�TIoN ( , I 1 i I r 4 6 ® - -- ----- SCALE: 1�0 1//,L APPROVED BY: -DRAWN BY DATE: * oq REVISED 114, DRAWING NUMBER