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HomeMy WebLinkAbout0022 CAP'N ISIAH'S ROAD - Health �_ 22 Cap'n Isiah Rd. , Cotuit _ 0, �, , %0it 4a'-TOWN OF BARNSTAB,LLE "SS " �- � 6 - V LOCATION �fS Ci�/ T /���/��5 �/J- SEWAGE # VILLAG 7- ASSESSOR'S MAP & LOT ri23 a INSTALLER'S NAME&PHONE NO. �GCI� G.XG�f1,l/D9i r/ivL� Z8 �,� SEPTIC TANK CAPACITY LEACHING FACILITY:.,(type) � /7/Gi `F�(l�,�• (size) x30 NO.OF BEDROOMS BUILDER OR OWNER 60 fL b IlVb 6 PERMTTDATE: - oZ 7' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility el' 7 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) S Feet Furnished by 4ar'l,/,lc/2 0- 4: /yAr�5 � � �` � � � � `� ,,,� � � � � � � � '") _ _ � �,�. .� d✓. � No. - Fee�l — �- j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppfication for Migogai *pgtem Cow9truction Permit Application is hereby made for a Permit to Construct( Repair( )an On-site Sewage Disposal System at: Location Add ess or Lot No l Owner's Name,Address and Tel.No. .t/7� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �3 / Type of Building: Dwelling No. of Bedrooms Garbage Grinder W4) Other Type of Building �✓1Gvu-� No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow 3_A0 gallons. Plan Date 719(, Number of sheets / Revision Date Title ��__ Description of Soil 1) ,�A- 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 not to place the system in operation until a Certifi- cate of Compliance has been ' thi oard of H Signed Date Z/2-26— Application Approved by4- Application Disapproved for the follo ing reasons Permit No. /l0 Date Issued ——————————————————————————————————————— TOWN OF BARNSTABLE LOCATION !C1` 4(S i�Pj /s/9 A0. SEWAGE # VILLAGE 0,,d 7/2 / 7— ASSESSOR'S MAP& LOT,��23 a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �.C�F/v�f� " � (size) NO.OF BEDROOMS_,_._ BUILDER OR OWNER a Y S I Ali b I/UG PERMIT DATE: r;2 - OZ 7- �V COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility ' 7 Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet. on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist J S � Feet within 300 feet of leaching facility) /J� Furnished by .-.265/./ F/Z Q o 3 1-7 � �Z �. .. ..Y . .� F ...� •, • ..{'. r '� .///A//"'''��1//f p/�Jf9/}.]��` � .�/J. �4 Y. •'o-sf .n _ No. / i '° Fee 0 _ THE COMMONWEALTH OF MASSACHUSETTS VV 0 PUBLIC,HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippficatiou for ;Dt9;po5a1 *pftem Con0truction Permit Application is hereby made for a Permit to Construct( �r Repair( )an On-site Sewage Disposal System at: Location Addr ss or Lot No- Owner's Name,Address and Tel.No. 7/_O y6i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t7/ar_ t�3 / Type of Building: bvKelling No.of Bedrooms Garbage Grinder(XIV Other Type of Building No. of Persons Showers( ) Cafeteria( ) r ' Other Fixtures Design Flow 3�3 U gallons per day. Calculated daily flow.:_., 3 3 gallons— Plan Date 7/94. Number of sheets / Revision Date Title Description�of Soil /,74 Nature o Repairs or Alterations(Answer when applicable) �•. fi .,F FY. `° `` ' '�� '/ � t oa Date la4inspected: 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'Certifi- h cate of Compliance has been� thi oard of He . Signed ` t Date Z 7 Application Approved by /. Application Disapproved for the folio ing reasons Permit No. 7&-- 6;4,2' Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of (Compliance - b THIS IS TO- I t3IFY,thaw a On site Sewage Disp©"sal�Sy e ioage/ (1tl )or repaired/replaced( )on by 1)J.00 5 ' for fSifs as has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�Z� dated Use of this system is conditioned on compliance with the provisions set forth below: P w No. O ' 2 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mig0al *p5tem 'Construction Permit Permission is her by granted to to nstruct is ( )an On-site Sewage Syste located at 5 Z Z and as described in the above Application for Disposal System Construction Permit.The applicant recog 'zes his/)her duty to comply with Title i;;edl owing local provisions or special conditions. All construction mit n two years of the date below. VA © c Date: Approved by i. i r' SOIL EVALUATOR& PERCOLATION TEST FORMS Page I of 4 Town of Barnstable BARNSTABLE, ° Department of Health, Safety, and Environmental Services MASS. o Public Health Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 FAX: 508-775-3344 ,Soil SultabllltyAssessinentfoT Sewage Disposal AsSSESSORS MAP Na` 3 12 PARCEL K NO. Date: -�6 Performed By: �� �C �� �i°�►` Date: O:Do Witnessed By: Location Address Owner's Name Lo�v►T, Lot#: �.� , Address,and Assessor's Map/Parcel: j7-21� Telephone# NEW CONSTRUCTION REPAIR Office Review Published Soil Surve Available: No Yes Year Published _ Publication Scale V =�-5i"O Soil map unit Drainage Class I Soil Limitations NON e--- Surficial Geological Report Available: No�, Yes Year Published Publication Scale Geologic Material(Map Unit) Landform Flood Insurance Rate Map: Above 500 year flood boundary No X Yes Within 500 year boundary No Yes �( Within 100 year flood boundary No OC_ Yes Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS): Month Range: Above Normal _%_- Normal ' 'Below Normal Other References Reviewed: ' DEP APPROVED FORM-12/07/95 FORM II - SOIL EVALUATOR FORM I 4 Page - C *aA oa— Location Address or Lot 140. T 1(A ✓� Ci�Tv l > On-site Review I� �1 Time: Weather Deep Hole Number t Date: -. . . . . ::..... Location (identify on site plan) Slope 1%) •3 Surface Stones Land Use fZP—S 1'0t9w*' Vegetation Landform .0 0-T W c,,S�- P w� i Position on landscape (sketch on the back) Distances from: Drainage way>�-S feet Open Water Body /Do feet Possible Wet Area > feet Property Line �Q feet Drinking Water Weil'>/OQ feet Other • DEEP OBSERVATION HOLE LOG' Soil Other Depth from Soil Horizon Soil Texture Soil Munseloll Mottling (Structure,Stones,Bout Gravel) Consistency. °� Surface(Inches) L o 0/2 2/1 yg - Sfva 60 - Go G oj,l0ylt 3� Lo a^f ,ny�2/z yLoomr I 8 _ 1 s o yl2 Deptht0aedrock: Parent Material(geologic) �2 -- �— {—' y e s Weeping from Pit Face: De th to Groundwater: Standing Water in the Hole: Estimated Seasonal High Ground Water: DEP APPROVED FOR!•t-12I0719S �l FORM 12 - PERCOLATION TEST Page 4 of 4 Location Address or Lot No. C dui r' OA COMMONWEALTH OF MASSACHUSETTS Massachusetts Percolation Test* Date: .. Time:, . . Observation Hole t! -T- # Depth of Perc Start Pre-soak O ,coo End Pre-soak S Y� �� Time at 12" Time at 9" Time at 6" Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Site Passed ❑ Site Failed ❑ Performed By: ITN Witnessed By: �5 Comments: . �.._.....-._�......... DEP APPROVED FORM•12/07NS , - - CI I FORM 11 - SOIL EVALUATOR NORM Page 3 of 4 Location Address or Lot No. TS C T—) IM Detennination or Seasonal High Water Table Method Used: 756 Depth observed standing in observation hole .. inches ❑ Depth weeping from side of observation hole... inches ❑ Depth to soil mottles inches ❑ Ground water adjustment ................. feet Index Well Number ....... ..._.. Reading Date ........... . .. Index well level . i Adjustment factor Cd• . . Adjusted ground water level ...._ Depth of Naturally Occurring Pervious Material Does at least four feet of naturallo occurring soil ab o ption pervious rial exist system� in all areas observed throughout the area proposed for the If not, what is the depth of naturally occurring pervious material? Certification I certify that on U 12 G (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 training, expertise and experience described in 310 CMR 15.017. Signature Date DF.P APPROVED FORM•12/07/9S e IN 4t�+�1 � �Kt�Tut�• ccx TEST HOLE LOG DATE: f-e,8ls TEST BY: WELLER&ASSOCIATES WITNESS:, �-->dQ kOC, \ PERC RATE: <72 T�G 42,5 "�gv.5' o T o►�> �� I L . 37,5 a- 38.5 \ \ Aa LCA SAGO IoYR -i ,,-,Ye 1— 58+ 37'0 4-,p,,,.ySgao 45 c- C _ G t r-Iav v�sa,rr] , ts11 N 32,5 l lam"3p 5 IZo tic> a 5.5, \\ , Lai 'T,tGt N �Zo 3 0096 /J / DESIGN DATA DAILY FLOW: (3) BDRMS. x 110 GPD =33o GPD AVM N SEPTIC TANK: 33o GPD x 200% _(oGo!+P✓3 N USE: 1SDc:> GALLON PRECAST SEPTIC TANK r ti�+ � a' � � LEACHING FACILITY: �-� o-�' • "`o ,G t=l.:\ (� USE:C3)'}'x g 'AlicIf at t ;�{5.5D �35' �J -5Tor o�sly ' 1� b ► CAPACITY: i_ 1 3g SIDEWALL: Eox 2_x:74-- ;It S. + lob A.* j � i ti � BOTTOM: to X 3: - ,-74-: -ZZ2..1 \�I •4o , \ 3,C.o `� TOTAL: ?� 4- 40 NOTES: rl 1. ALL PIPE TO BE 4"DIA.SCH 40 PVC. 2. PIPE TO BE LAID LEVEL FOR 2'OUT OF.DISTRIBUTION BOX. 3. RAISE ALL APPLICABLE MANHOLE COVERS TO WIT IIIN 6"OF FINISH GRADE. 4. SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A GARBAGE DISPOSAL. 2"LAYER OF 3/8"PEASTONE OVER 5. SEPTIC TANK AND DISTRIBUTION BOX TO BE INSTALLED %' 3/4"-1 1/2"WASHED STONE ALL P, ON A 6"LAYER OF STONE. AROUND TOP OF FOUND. @ EL. �45,50 / io^ u^ -rof a �-- 47°3o + / �� 43 00 4z,X 4z.5o 42.t7 4Z' >®-9 1 c 38.co 1B6f 1 c. �. 39,70 41,70 RE C'l/ IHpECVjc.►iS h .IRt_ Paz SEPTIC SYSTEM PROFILE -A 6' 7-Ad>ds ` 0-do0-r412- u�(t�Y. Ste. SITE �- SEWAGE PLAN GENERAL NOTES 1. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION FOR OF ALL UTILITIES,ABOVE AND UNDERGROUND,PRIOR rrr-T4 �� ALA%T,�+a. TO ANY EXCAVATION OR CONSTRUCTION. 2. SEPTIC SYSTEM TO BE INSTALLED IN COMPLIANCE WITH 310 CMR 15.00:TITLE V. PREPARED FOR 3. THIS PLAN IS NOT TO BE USED FOR PROPERTY LINE DETERMINATION. ATE: iJty✓. 2c�, 1�q(y SCALE: IDi=p� 'V111 OF Mas r S+ : el t r, .,.r.,ra n i -+ 726t15C y WELLER &• •ASSOCIATES 714 MAIN ST. P.O. BOX 119 YARMOUTHPORT,MA. 02675 TEL: (508) 362-8131 APPROVED BY: