The URL can be used to link to this page

Home My WebLink About0059 BLUFF POINT DRIVE - Health 7- C� N SMEAD KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINABLE FORESTRY MIN.RECYCLED INITIATIVE CONTENT10% C.rt1fi.d Fiber Sourcing POST-CONSUMER www4fiprogra=rq SF INO MADE W USA GET ARGANM AT SMEARCOM i Town of Barnstable PH Department of Health,Safety,and Environmental Services a Public Health Division Date Z e Q, 367 Main Street,l lyannis MA 02601 i aAM1atABt� i Date Scheduled Thne MA Fee Pd. 160, C w-&& /_5 Soil Suitability Assessment for Sewage Disposal Performed By: 9ETLi?_ 5 V L_L_i V kvV ?(f Witnessed By- t p 2s'`1`k p t `G F t34uvn YatATY0�1 C N't1tA YIVfI11V1ATUN...: . ... . . . .. . .. .. . ..:..�. .. .... Location Address `„p^r � Owner's Name 10Lui'r- rO- UT Q2tVe �� c1c C\ God, �T I Address o$omi(o5 99►"L�eV t-�-L Assessor's Map/Parcel: 0 3 q -O(0 Engineer's Name gqa%z-:(L Sv w�vajv NEW CONSTRUCTION X REPAIR Telephone M Ae)-S34 Land Use Slopes(%) 5--Z-011 Surface Stones "ID is Distances from: Open Water Body 11 at) It Possible Wet Area MO It Drinking Water Well �R Drainage Way 10 It Property Line t 10 It Other n SKETCH:(Street name,dimensions of lot,exact locations of lest holes&perc tests,locate wetlands in proximity to holes) �p 1 J�l ��`�� ► E1, 10•S 44,vp r . 6�� P1° L L G tO"D 4! L 1_C Parent material(geologic)D VTR A5 La,►&.3 Depth to Bedrock 3Gb' T L J S Depth to Groundwater: Standing Water in Hole: (0 9r/ Weeping from Pit Face 140 Estimated Seasonal High Groundwater GVLyutu►Owu OrMQ, 0bSTp"60 2.3 tA6V NCB TO AOJUS.T :......:..:. ma FEs 4 e. 11 E1 mNA. '1C1 Y' 'C11t S �1SU�1A7I.(7 'V 'EXt' 'A3L '► Method Used: LIS :': FR1mPtEQ it lAt.i.owtz0 'C VSr,ALr W)TD PESTI;VC�� AS�a�L G�u►L. Depth Obserfed standing in obs.hole: G 9 in. Depth to soil mottles: 40"G In. Depth to weeping from side of obs.hole: ► a In. Groundwater Adiuslmenl ft. .index Well#ftm,Q -Reading Date:. Index Well level„ - _ Ad).raclor. Ad).Groundwater Level :.. PERCCJ�LATI' TEST bite 'rtme, +; ............:::.::......................:....:.:....:..........::..::....:.....:::::.:...........:::......... ..... ........... ... .. .. Z 6-CAL1_aivS - /2 A9/N -LEss-thpa Observation Hole 0 2 Time at 9" Depth of Perc Time at 6" Start Pre-soak Time Q StO� I¢ft�i Time(V-6") End Pre-soak ,}- RateMin./inch LEss / N Z�AVV Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) �d Original: Public Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant DL»Yy:c� six� rr�rt xxx, t Depth from Soil Ilorizon Soil Texture} Solt Color Soil Other I Surfnce(in.) (USDA) I Consistency.(Munsell) Willing (Structure,Stones,Doulderes. /Y e .s o/GAN, INN+ I rr , J"aWOU cw.orsw FtIVE RaotS 13 S100iyn /O y2 5 3 13'= .30" f3 �a e �i rr YQ -z - 2 ' Lt. Y�L•at^- 6/IIiGLE G/��w 30- 7 L' rs6 /G 2 t7 �R7� veom Vrot—I'se%;CA041 : Depth from Soll Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consistency.e ar d PINe/Y�6a 3 - v Chavell O aTAP. Ma-r K n BrOLV A,CaA 14 la Ya. S 3 FIW6 .2,rt 1y=31' B yet-. a toww 6 sAWn IO YR S L 2-0l s „ C Lt. YSL.arn. p G 5),V44e Cr,41A-r . DCI (�T3S�R�A, 'I(�N XUY• �•U :> IYail :# Deplli from.... Soil Ilorizon Soil Tezlnre Soil Color Soil Outer Sul (in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. e Oravell OI3RA`rI01rCHtrl #: Depth Rom Horizon Soll Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Flood Insurance Rate Man: Above 500 year flood boundary No— Yes iC 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 pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? E5 If not,what is the depth of naturally occurring pervious material? Certification nA I certify that on HBt21 L-95' (date)I have passed(Ile soil evaluator examination approved by(lie Department of Environmental Protection and that the above analysis was performed by me consistent with the required t ' g,expertise nd a erience described in 310 CMR 15.017. Signature Date 177 LOCATION E W A G E PERMIT NO. VILLAGE INST LLER'S NAME 7� ADDRESS IBUItDER OR OWNER DA T E P ER MIT ISSUED DATE COMPLIANCE. . ISSUED f2/1y1� � r � _�°� fox 4 ' No.. Fes$... ........................ THE COMMONWEALTH OF MASSACHUSETTS BOAR...... F A T ---._.............. ..._........----...OF. . ------------ el Appliration for Disposal Works ns#rnrtinn Permit Application-i hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal �Sys t l 4y- __ ...._ n• ts o ddress N . .71 Wd er i ---------f -------------- rInstalle Address e of Building Size Lot... .. ...:.. �._Sq. feet ____________________Ex ba Expansion Attic Gar bag Grinder a Type Dwelling—No. of Bedrooms.__.___.____ p ( ) g a4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures .-••----------- -•-•--------------------••--- W Design Flow..-------. ------.--gallons per person per day. Total daily flow_-� .. .......................gallons. WSeptic Tank Liquid capacity/5 -_gallons Length................ Width---------------- Diameter................ Depth................ �x Disposal Trench—No./................... Width....__.............. Total Length-___-__-____ Total leaching area-------------_ __ sq. ft. Seepage Pit No ........ Diameter......ly...... Depth below inlet.................... Total leaching area....Yl sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- ---------------•••--••-•••-••••••-•--•-•••......•--•••-•-•••••-•-- Date---------------------------------------- Test Pit No. 1..... `minutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ........4........................ ... ... ...Ap....... O Description of Soil....... x Uw ----••-----------•----••--•-----------------------------••-•-------•----•-••-•--•-•-----•--•--•-•••••-•....•:•------------------------------------------------------------•---••...-•--••............-- Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of iss Compliance has been ed by t and o th. Si --------- .._ • -• --•--•--... .. __ ...... ...................... ...... - --.. _ .... Application Approved By--=---_. . ----.... .--.----- ....... .. _ ...... 0---- -- Date Application Disapproved for the following reasons----------------•-----•-•-•--------------------••-----------••------•-•-----•-----------------------------•----. -•-•......••-•-•--•-••••--••-••••---••-••-•----••••••••-------•--•-•--••-•--....-•--•----•---•.........•.••-••--•-••-•••---•-•-•-•--•-••-•-••......-••--•------•---••••-•--------------------------•.... Date PermitNo................................................--....... Issued........................................................ Date 7A, Ll - No. 0 Finc.......... ft................... THE COMMONWEALTH OF MASSACHUSETTS E10ARD-OF HEALTH / ................I....OF.......................... --------------------------------------- Appliiatija'u for.Disposal Marko Tonstrurtion Permit Application-19 hereby made for a Permit to Construct (:oO) or Repair an Individual Sewage Disposal System at:f .............----- .... .............................. ............................................................ Location-Address or Lot No. --j"N' ................................... .............................. ............................................................... wner,��,',. Add ................. ..................................... .................... ............. .......................................................... 7 Installer J Address Type of Building Size Lot.___-/_�..................Sq. feet U Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder Other—Type of Building ..........................11�k No. of persons......._.______..........._. Showers Cafeteria P4Other fixtures .............................................................. i e ................... __ Design Flow....I/........ --gallons.per person per day. Total daily flow....._ .___...._ ..............___...._gallohs. 94 Septic Tank Liquid capacity ____gallons' Length________________ Width_-___.__-__---- Diameter.____...___..... Depth.-.--__-__---.-- y p Disposal Trench—No Width/ Total Length------- sq. ft. -------------- _4��------ Total leaching area----- Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ) --. - Dosing tank Percolation Test Resul;/.&*"'Performed by.......................................................................... Date---------------------------------------- �_l Test Pit No. 1.................minutes per inch Depth of Test Pit........_.______-__- Depth to ground water------------------------ Test Pit No. 2----r62------m;In tes, inch Depth f/Test Pit.................... Deptbeto groun(I water--_------------------- IVI...70 0 Description of Soil____________________ 6..................................... ....... ...................................................... U ........................................................................................................................................................................................................ W :......................... �0 ---------------------------------------7-----------------------------7- ....................................................................................................... U Nature of Repairs or Alterations—Answer when applicable._.............................................................................................. ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further-agrees not to place the system in operation until a Certificate ;?o_)iaSnce has been issued by the board of�liealth -41 1�V", ................ -------------------------- k /CT... Application Approved By............................................................... ---------------------------------------- 17 Date Application Disapproved for the following reasons:............................................................................................................... ......................................... ................................................................................................................................... .................... Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALT OF MASSACHUSETTS BOARD A TH '2�PF..................... ............................................................... .......................... ............. . irate AT of womplialta Sewage isposII .y t m onstructed rRe,aire ........... ... ....... .. ........ .......... .. ........... ... .... . . . .......... .... ......... �*.......... at.................... ............... ......................... --- --- ----- .. ...................................................................... ------ --- ------- - ------ ------ ----- "' -------- has been installed in t State Sanitary/fi*de.-AydWspri�d in the application for Disposal Works Construction Permit No......................................... dated.:..._._...._._....................___._._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT.BE CONSTRUIED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .. ... . . DATE.............. 1 7 -------------- 7------------ ---------------- THE COMMONWEALTH OF MASSACHUSETTS 71 BOARD 6- dam. a ........OF................................................. ................................. \No.......................... FEE........................ Rap Vremit ............... ....................... .... ............ .......... ........ utaSe s jL ............. Per is 'on is h y g h/ to Cowu atNo........................................................... ............................ eet----- -- --------------------------- v._;Z lr;�.7�...... as shown on-the application for Disposal Works Constructtt it 0Ar/.qted.......................................... . ............................................................................... ... ................ Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS