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HomeMy WebLinkAbout0019 MAPLE ROAD - Health (2) 19 Maple Road Centerville A = 189-074 5111 �� UPC 12534 No.2�153L 0 No. �. I — 3 a Fee 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS applitation for 30isposal 6pstrm ContCUCtion 3pPrmit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) (�Complete System ❑Individual Components Location Address or Lot No. 1 tz`.�/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel � 1 1 en' i' ' o Y (:An &r 5on Installer's Name,Address,and Tel.No. P C)fZ_d Designer's Name,Address,and Tel.No. C C Const +i- G, S • 17ervn►S MP, Gagjlp SO,(- Type of Building: OZ OLOC7 Dwelling No.of Bedrooms 3 Lot Size I S t H(D77 sq.ft. Garbage Grinder(N 60) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided L-top gpd Plan Date i Number of sheets Revision Date Title Size of Septic Tank S f�r1 Type of S.A.S. 600 QCJ Z)YU� w y Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the co ructi and mainte re escribed on-site sewage disposal system in accordance with the provisions of Title 5 of th o ntal Code and not ace the system in operation until a Certificate of Compliance has been issued by this Board of ealt . S' ed A Date V-D`t G 'a Z za L Application Approved by f Date )2—,2 d`=f/ Application Disapproved by Date for the following reasons Permit No. � 0 I �f'3 Date Issued No. 0 I I 4':ta. +I+ Fee 4 i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes i PUK IC. HEALTH DIVISION ;-�O1,IfIf,LV<OF BARNST�LE�NASSACHUSETTS 4plication for 'Osgosar 6pstem Construction Permit Application for a Permit to Construct Afil Repair( ) Upgrade( ) Abandon( ) ]Complete System ❑Individual Components Location Address or Lot No. ` n-, PLC Owner's Name,Address,and Tel.No. Assessor's Map/Parcel , -1 4 y C9^ �`!� '. ' l(\Y 1"'t r ) Installer's Name,Address,and Tel.No. O 12�� •1 ��,Designer's Name,Address,and Tel.No. <'�n r; r i,\ C J sod-ve �� ;-r Tr�C Type of Building: i✓ZI�I�Cr' Dwelling No.of Bedrooms 3 Lot Size S ,y�� sq.ft. Garbage Grinder(f\ h�l Other Type of Building VV Osc No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided U gpd Plan Date Number of sheets Revision Date n C`f1P Title S-- iG cJ( S� < rY-) Size of Septic Tank Cj OC-) Type of S.A.S. 5O(� C(C� bl Lj V.X Description of Soil ` CCe_ �t,� �111 C�Iuon CO0VS� , 7, Yck\j Nature of Repairs or,Alterations(Answer when applicable) 1 Date last inspected: Agreement:, The undersigned agrees to ensure the co tructi and mai rxanss•e a ore described on-site sewage disposal system in accordance with the provisions of Title 5 of th iro ntal Code and not t ace the system in operation until a Certificate of Compliance has been issued by this Board of ealth. S�' ed IPrttZS Date V-)%.t r- a�Z`•ta ( t Application Approved by tti,. Date 11- 0 Application Disapproved by Date for the following reasons Permit No. D 0 Date Issued • --------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS Certificate of Compliance THISS IS TO CERTIFY,that the On-site ewage Disposal system Constructed(x) Repaired( ) Upgraded( ) Abandoned( )by o'at hall"been construqed in accordance with the provisions o Title 5 and th for Disposal System Construction Permit No.. ,dated Installer Designer #bedrooms 3 a Approved design flow 9 3 o gpd The issuance of this p5/36/ t sf all not tie construed as a guarantee that the syste �functto des' ned. Date / ' f Inspector --------------------------------------------------------------------------------------------------------------------------------------- No. I ` yse Fee /Sy THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction permit Permission is hereby granted to Construct O Repair( ) Upgrade( ) Abandon( ) System located at f /1n h and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.", ermit. j Date ?CJ Approved by',,V i I TOWN OF BARNSTABLE LOCATION iq AptPL 1-OPcO SEWAGE # ZOtt �134 VILLAGE ASSESSOR'S MAP & LOT lam' 01-1E INSTALLER'S NAME&PHONE NO.C—.0. i;y S��ye-s��ty,"ccJC . b�u 3y�►-1�1,t .SEPTIC TANK CAPACITY 1 o �6a",o N LEACHING FACILITY: (type) (size) 5rib � Lz� NO.OF BEDROOMS BUILDER OR OWNER KAaL Arejoeg_eom COWNRC:) PERMITDATE: `'2 I va tt COMPLIANCE DATE: t 213® W Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility yJ J A Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ;�4 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Pc Feet Furnished by Aa Colzong. tia�se CoRR C. ",L;st O �� 8P•5¢.ree� �u�x��a�0 6 r L"(:t 36'66 � � a1 '•� ��t �t4 Town of Barnstable �FSHE t Regulatory Services M Thomas F. Geiler,Director x BARNSfABLE, MASS. i639. Public Health Division �� A'ED1AP�A Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form .4 Date:. / y /Z Sewage Permit# ZD 11- 4318 Assessor's Map\Parcel 0-7 Designer: Installer: ,C-, Al Address: 923 , v%� Address: 7.b, y,4,3 p�tyyylS WLA �"L�:C,�CI On JE Z S I G t C, Co N517-u c-r l on3,z14c.was issued a permit to install a (date (installer) septic,system.at .19 based on a design drawn by (address). —r—�- /� S, 1� dated' /z �f z�/I. .�u�v S c-�= /z�z 3�Z-o/ . (designer) .. -I certify that'the septic system referenced above was installed substantiallyaccording to the design, which may include minor approved changes such g Ppas 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. ater than 10' 1 eral relocation of the SAS or any vertical relocation of any component. o the septic s e ) but in accordance with State & Local Regulations. Plan revision or c rtified as-b i1t designer to follow. "lam' S7Pt;S nstaller' Sign e) f�� � { rL , IVIL Kilo.3a461 � r ( esigner s ignature) (Aff x e gner's Stamp Here) PLEASE_RE.TURN'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`\Septic\De`signer Certification Form Revised.doc W. f h yp i LOT 4 y h j ) S a 4 63 A.ill O � a � / p LOT ti � - BLOCK' A) A.M. 189—74 tz 88.38' 95;00 - — ,lLAA I C LOT I LET r NOTE' AA PRE—EXISTING, NONCONFORMING. ` °a 4 FLOOD PANEL: 250001_0015 C FLOOD ZONE. _ C' DATED. 8119/85 here_by certify that, this lnor-.tgage nspecton_plan .was..prepared fo• Plk is'For WASHINGTON MUTUAL, ITS SUCCESSORS ANDfOR ASSIGNS -ATIMA Bari" Use Only`The location of the building shown does fall within a special flood hazard zone. DEED REF. Per .taped mspectfon it""appears the location of dwelling,does conform to the locQ� by-laws' PLAN REF 13�1 J3 _ , in effect at the time of construction° with respect to horizontal`dimefisional'setback regrurements — ----- or is exempt from violation enforcement action under Mass. General laws Ch. 40A Sec 7 Referenced Deed subject to and.with--the- benefit of allrights,._rights. of way, easements"reservations SCc2IG' 1 __s�Q _—. FT. and restrictions of record, if any there be and insofar as the same are of legal force;end,effect Dater 111204 _... .. - PLEASE NOTE. The structures on this inspection were located by tape not.instrument and are approxrmate only An actvaJ-survey is necessary for a precise determination of the building location and encroachments if any exist eitherway across property lines Thls'rnspection must not be used for recording purposes or for use m preparing deed descriptions and must r buildmg plan_purposes This inspection must not be used to locate property lines Verification of building locations property line dlrne'nsions .fei:ces or7ot configuration can only be accomplisbed by an accurate instrument survey which may reflect different infoimation=than what`1s shoiviz hereon: This•inspection is not to be used for any purposes other than moifgage. Yanlree Survey aacepti -no responsrb;lit ,}o azR$ges^ S,ult1?3 from sefft ie7rence. j� r j �•"y �!. s PHONE. 508-428-0055 Y�NKEE' SURVEY V EY COl �' SUY—T, Fax 508-420-5553 UNIT 1, 40 INDUSTRY RD, MARSTONS MILLS,,.-�fA 02648 . 7239 JS' F� � s�- �L�n �� -�� �h r �� � � �� � � i �h` I� � 1 � � �� , i � F � � Town of Barnstable P# r' Department of Health,Safety,and Environmental Services THE Public Health Division - Date 367-Main Street,Hyannis MA 02601 • 8AnNEMABLA "TEp next Date Scheduled Time_ Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: LOCATION & GENERAL INFORMATION Location Address Owner's Name � � AA."De--ve-5cr� Address 4,W--ter CL-+���-vr z LE ,C.H Assessor's Map/Parcel i$q/'7 / Engineer's Name ri�-4--1 A . NEW CONSTRUCTION REPAIR ✓ Telephone 11 6_0J3 3Co'7 1 (og ! Land Use Slopes(%) �' Surface Stones i Distances from: Open Water Body 4" ft Possible Wet Area ft Drinking Water Well ft Drainage Way 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) Ail t0T 3 �^.J C C.i Parent material(geologic) 74 Depth to Bedrock 2 Depth to Groundwater: Standing Water in Hole: / 7i�C Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL`HIGH WATER TABLE Method Used: "X-oW_-- C +� 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 H Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST „..bate . z Time =� Observation Hole# Time at 9" t� Depth of Perc Time at 6" Start Pre-soak Time© Time(9"-V End Pre-soak Rate Min./inch LZ Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------� Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Ilorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel) 0 � � l.S jb�ltr3/3 DEEP OBSERVATION HOLE LOG " Hole# ` 7- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency-% r vet DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Grayel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency-%Gravel) Flood Insurance Rate Man: / Above 500 year flood boundary No— Yes Within 500 year boundary No f✓ Yes Within 100 year flood boundary No ✓ Yes Depth 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 pervious material? Certification f I certify that on 11/ 14`� (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 traini xpertise and experience described in 310 CMR 15.017. Signature Date /L i 77 V I'47 ttFI'.M4YJlMUV"COVtR E AL:..: :GEN R WO TES,�:VE:R-�-T�:�:-!-EL���,E��V' A,i:T�I 0 Is.;-MUST,-eb�tWS 4E WI THIN IOE -10 �a I D­INVERT,,AT*6UIL'D1N6.',#I,-2 tTO,JRSV� ,:THIS'PLAN I S",-FOR 'THE-DESIGN�AND'CONSTRIUCTION t IN V I NG *2 103,J­ Cry tILEVEL MIN 2t7 ,OF�'PEAS TONE SEPT C TA THE:�"BEDROOM'.&WI 3 t,75-, t - -0 OR ' I L TER BE tY Y .SEWAGe.,0106SAL K I "f'/ I VIER Tl CA L� DATUU-IS �ASSUYED, Fofi,.BEXCH�MARKS,."s rl:�GAS '�SEE':S TE 'PI DOUBLE,- A 102�47 SHED-,S TONE 2 J NVER T,,'OUT itC TAN'K:2.0 T PER 1. OUT,DIST' .�,80X,FIL IA REOI L02.SAP1 Ib2 0 CONS TR TION METHODS AND,'M4 TER IALS'AND`G.P D �,,X OOV,�-Ii:t-66O.,GAC '330 J.OU x YS CA M'OF AROUND.,'�12'8 BO TTO L EA CH 100 w 'CHAMBER 0 L TER., -M ss. D.E P. -TI AD�WED GROU D, WA 1506�-CA A AND SEPtIC' ANK, VIDED.- ht 'SEPTIC S �iY'SHA L L*14 TONE' 2 T PR6` M150 ORM' io tir :5 , tO'CAL, ItN $O' IL""ABSOR"PTION' SY5'TE*MVR'­E­OU1R'E'D; D�,OF 'HEALT REGULATIONS.ISEPTIC;TANI- "CRUSHED,$TONE OR OBSeR VED'GROUND WA TER. ROAR N-5 INIINCH�-PERC RA TE CTED A S�:COI 80 rro NO 9 FrrST Lt. 4 Diil Gk 4 COMPONENTS L OCA rE 'UNI L."TEXTURAL tCLASS -SYSTEM L L�,.SEP I I C­ r VEHICULAR TRAFFIC,OR GREATER.� 'PROF� `E: NO T P*O''-' A suBjEcr, o;IIII/SF'; AREA '0:'�Wl TH--j�O GPD PA 'E,46, S.F. REOUI RED IWDEPTH SHAd" BEtA' 0 THAN :J'� IS TA INDING H-20"'WHEE OA P OVIDED.�2 GA L 6HAMI ALL-SEWER PIPE SHALL. B �SCH DUL 40 PVC OR.10 A ROUND. A 47 F D.74 348 I4'71 -S'-F W)AL'APPROVED G.P.D.%. -6 SEPTIC.�, ANK. ND' -BOX�SHALL BE , CIWORCED tT ICONCRE �D R-.-DA TA PRECA$O TE �bR�-":�PPROVED,,,�POL.YEtHYLEAiE WA TER ao rH SHALL. aE,,wAftRrioHr.' D BOX SHALL::BE: I AID I CA TES TESTEED,FOR LEVEL'WHEN "THER -1 S'MOR. HAN ON t6N OBSERVED E t,6ROUNDWA TER TEST PERCOLATI OUTLEr. ,�':TP *2 'DIG BeFORE 'CONS TRUCTI ON'.CALL - SAFE-TP 0 I` IP*1'3493 7. LOCAL" WA TER ' .,OR I ZON TEXTUR THe 0. COL&� COLOR OR IZOk TEX TURE. FOR I OCA TI ON OFI�IuNDERGRouw urIL?TIE$'. Ilosic O* 65.t 'SEPTIC.SYSTEM INSTALLER SHALL -NOTIFY THE.,8.---- - - - - - - - - . . . . . . . . . .—. . . . . . . . . . -IOYR 'LOAMY- -fOYR- --- - - - - 104.8 3' 104 7 DESIGN ENG I NEER :TWO:DA YS PRIOR TO ,CONS TRUCTION 2' L OAAfY-SAND OFJHE SYSTEM ,TO-ALLOW FOR SCHEDULING OF THE 3/3 SAND 31.3.. . .. . . . . . . . .. '9-- - - - - - - - - - - ­ - - - 104,'J S 89609'00*E:, I 104.3 CONSTRUCTION INSPECTION$.IOYR OYR L OAMY IJ4.64' L OAMY,5B 9. -EXISTINGCESSPOOL TO'BE,PUMPED DR Y,AND SAND SAND 416 I-24'—26- I 6�� 8 - --- - - - - - - - -— /03.0 BACKFILLED.ILOT 3 M�b-C RSE IOYR MED COARSE OYR SA ND A ND 516� �smo-,AND :516 1.5.4671 S. F. .'GRA VEL 46" GRA ViL FrN It SEPIC TANK 12 NO WA TER -NO WA TER 1 2� 94 0 D-BOX �'5 el DA TE DECEMBER 7­2011 TEST BY: STEPHEN HAAS I3.,?P FM, ' ESMARAIS Y IPERC;'RA AE: < 2 A41NIINCH t2-500 GALLON-7�LrAofrAo CMMS Ok. CORNR OH W14' MAE AROUND EL 105.56 IW;II4-N 89*31 '30"W -M DE7 S 'ON-P T-: C s Y S, TE'I0 -4 MA P L'E7 R OA D MA P 89 F RC E L �7 A ,� NTER V LLE B ARN S T�o"' B 'L E7 E",tMA t'd R ' :—PREPARE -Nt)ttGE A -D R S 0 K.A R"L N. E � .LE CONCRETE,BOUND " WESTEPN 'R O A D --+�A R W CH �MA- 02 64� 50 (�2;R E At T,ICi—W— WA TER,L 0 CUS—oft INE .. , , 11 1-1�:­ .LD E 20 [S L'E* I t2 0 tCE B E R A L ER!4eD HYDR NT 140 IF N G-L NE GA S't0 VER 4LIE,4D III RE,S ', E'A V'�E OHW L IOHT:,PO$IR a Lj t L- 6A 3 7 Y a r n-io u t h p o'r t '-.MA 6 5 , UNDERGR ECTRIC'ONE 0 77 - '(:5 08 6 2-81 3 2-UNDERGR UND EPHONE, tT C T V-7' ON —5 I14NE UNDERGROUN C48L VISt 2 3 .3 40.'4 S OT LEVA TI N I­-EX!Sr0Vd-COI` IREV 1,SE.0: ,`DECEYBER',.2 �'20'WO CF.WIEEA, W, .:CHECK "DRN A 20 40 t3: ,CFW O;, 0 NO-COkTP' UR' tItII