HomeMy WebLinkAbout0052 EISENHOWER DRIVE - Health �l52 aEisenhower Drive
C)tuit
A = 039 099
T'OWN Ur'BARNSTABLE
a
LOCATION- 5;1—°Ct,ORnn cwrew ____ SEWAGE #
VILLAGE C � ASSESSOR'S MAP & LOT q
";INSTALLER'S NAME&PHONE NO. aswl
A
SEPTIC TANK<CAPACITY J.5
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS
BUILDER OR OWNER 50tUx W d,Q QAzi t6w i
PERMIT.DATE: COMPLIANCE DATE:
Separation Distance Between the: '
t.
Maximum Adjusted Groundwater Table and 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 . !�' ? i\ f
r
® � r
�bj
4 7% 1 26 �C(
a?-
C40.1 = 67"
1 �
4 Sh3 = � J
< C46 3= 69
No. 2�0 U Fee
THE COMMONWEALTH OF MASSACHU}SETTS '' Entered in computer:tG
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01p plication for Miopooal braem Con.5truction Perron
Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 39
Installer's Name,Address,and Tel.No. °(p h�r� ?ac. Designer's game,Address and Tel.No.
wet
.2w cran J
Type of Building:
Dwelling No.of Bedrooms Lot Size2lg N�sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /5ryo Type of S.A.S. LCO&A
Description of Soil iE� `� P�A✓1
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 issued by this Board of Hpalth.
Signed Date 9
Application Approved by PVJ Date i -a2-2-03
Application Disapproved for the following reasons
Permit No. ?U 0 3 0.? f Date Issued l- c?2-d 3
} No. �tl�3-�35� E Fee / od
THE COMMON� Yes
W�E�A�L-rkt,OF MASSACHUSETTS Entered in computer:t
r,. r.+1
PUBLIC HEALTH DIVIS(ON -TOWN OF BARNSTABLEs MASSACHUSETTS
Application for �Digoo' i *pztem Construction Permit
Appli ation for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) /Complete System O Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel 3 9
Inst2aller'�s Name,Address,and Tel.No. O LO h�i,t T c. Designer's. ame,Address and Tel.No.
C0 5Ta)L
y
Type of Building:
Dwelling No.of Bedrooms' Lot Siz -4 _sq.ft. Garbage Grinder( )
Other Type of Building '•' No.of Persons Showers( ) Cafeteria( )
Other Fixtures t
I;¢
Design Flow 3 00 67� gallons per day. Calculated daily flow gallons.
Plan Date /I.-f -a"Z-- Numbercof sheets Revision Date
Title
Size of Septic Tank ��� Type of S.A.S. L&AeAl _ s,•. �S
Description of Soil z, G�1av1
1
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 issued by this Board of ealth.
Signed Date 9 3 e
Application Approved by 2d 'P�j -S. Date
Application Disapproved for the following reasons
Permit No. -2 U U 3-D 3 S- Date Issued l- a 2-0,3
----=` ------------------------------- --
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed()6)Repaired ( )Upgraded( )
;Abandoned( )by '
at S2 �S C'OTU �— has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 20 o Z 0 3 f dated /-__)?- 3
Installer Designer
The issuance of this p it hall not be construed as a guarantee that the syst it ti s d s1 d^
Date "I �� 3 Inspector
v
———————————————————————————————————————
No. )yo? '03S Fee U�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
1=i!9poga1 *p!tem Construction Permit
Permission is hereby granted to Construct X) epair( )Up rade( )Abandon( )
s System located at =�3 0� r I f, r
� I
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 t pe it.
Date:_.T -u 3 Approved by , �� ���
TOWN OF BARNSTABLh
�p a003 35
LOCATION Sa! Cl °'s'�.."'�`�" SEWAGE #
VILLAGE f?w . :� ASSESSOR'S MAP &LOT "0�1
INSTALLER'S NAME&PHONE NO. + .
SEPTIC TANK CAPACITY i
LEACHING FACILITY: (type) p^^r (size) I
NO.OF BEDROOMS
BUDDER OR OWNER
PERMIT DATE: o`� COMPLIANCE DATE:
Separation Distance Between the:
Feet
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility
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 Feet
within 300 feet of leaching facility)
Furnished by_ • u "'�
1 '
EL
ri Rk 41
j
1
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I
I
Town of Barnstable . P#
°FY►,E
l� v
Town
Department of Regulatory.Services
a"""S'"a`4 ' Public Health Division Date I 1 �1 �2
NAMplEn.79..t a 200 Main Street,Hyannis MA 02601
Fee Pd.
}Date Scheduled 1 2 Time
Sbil Suitability Assessment for Sewage Disposal
Performed By: ��c*1 l a• � �0` \,r Witnessed By:
—r-----
:
•s
Location Address
1j �c S`C�y 1. £LPuRp o�,
f Address P'CP� e�dl.�—C��Gn� 0'l.�0
Cv�v rnAKS'to�� M�L�.S Mo , 49.
Assessor's Ma arcel:
0 Engineer's Name G O P STM► �1S L .
NEW CONSTRUCTION �_
REPAIR Telephone#
Surface Stones
Land Use S L Y7 A L' Slopes(%)
Distances from: Open Water Body 0 D—k, ft Possible Wet Area
7,0 0 ft Drinking Water Well �C"r ft
Drainage Way ,d ft Property Line y�—ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands in proximity to holes)
TO -�
_
PLI E
Depth to Bedrock
(gBolog
Parent material° is) Weeping from Pit Face
_ C'U1t� NTj�
Depth to Groundwater: Standing Water in Hole: ����
Estimated Seasonal High Groundwater
'N�fflrj�WE
1i`,fiFkik�P i n i a
aal na ww
Method Used: p in.
Depth Observed standing in obs.hole: in. Depth to soil mottles: ft.
in. Groundwater Adjustment
Depth to weeping from side of obs.hole: Ad• factor Adj.Groundwater Level_
Index Well# Reading Date: Index Well level • J
WWI
`�„'' �' . .r<.
Observation ?=" ' ' r Time at 9"
Hole#
• r ��61 'l 8 � Time at 6" V'
Depth of Perc
Start Pre-soak Time
0 :0 Time(9"-6")
O : o A
0b �.4D
End Pre-soak
Rate Min./Inch . I
Additional Testing Needed(Y"
Site Suitability Assessment: Site Passed _ Site Failed:
r'1
Original: Public Health Division Observation Hole Data To Be Completed on Back-- --
'ter
i
� 2 ae r.;�rra rv;'
...;..+,.�.. ia:�^+vv � .. i ;. •..i,. �+•,,.;.�„ + ,r�
gl,,tp 1 d� '''f�':l vn4 .. ., i ! ,�":r5 c,��.,.. � "nl':al� ,!5 'lt' '•a� �y h. G i I�t!c�.�'G:��� r +
++II�'^�.di,'f;' Phi'�h3'I+i
Ili I. tl,.ilidl.n+. +.dh. k.
Depth from Soil Horizon Soil Texture Soil iColor Soil Other
Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders.
Consistent %Gravel
3�" bqR (OH aoue ods�
��. 'f �.i 4�,u4+I+•ill
8'uNC6dn !I `) r )1Ju" a
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) "(USDA)- (Munsell) Mottling Structure,Stones,Boulders.
Consistent %Gravel
Slog
3co""13b4 C' SANS to l9 � A ES--S Loa sc
r�
t
"+ I�:.�;;iq:, -g; ,: ,,,,,;. r+v_ .,y .. v_ — u :ri( 7:�i nevi`•Y-X' 'A mp F�
I •1 7' T„IyI �M4+�.`I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
•R•Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders.
Consistency,%Gravel
k
.. ;. ij - I ,JI I IP''I. i*. i +5;Im�i. i l t(
�' ��, �i a. I ; ��'. + u� r Ifl`� 3�' iII ` �� � p6'll +}�i
+g + R
I�G� rJlu°r �Glli 'X W fRlb t I�, >kikl , iSs .m
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (US ) (Munsell) Mottling Structure,Stones,Boulders.
Consistency,%Gravel
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No X 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? >us
If not,what is the depth of naturally occurring pervious material?
Certification r
I certify that on `O v (date)I have se th it valuator examination approved by the
Department of Env' nmental Protection and t th a e alysis was performed by me consistent with
the required trai ' g,exp ise and perienc esc e 3 0 CMR 15.017.
Date 16 b Z�Ol4 Z
Signature __ 1_-
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