HomeMy WebLinkAbout0061 FOREST HILLS ROAD - Health 61` Forest Hilis Road ��� '�'�'� °
Cotuit .
025 ,007007 '
1
�7 TOWN
f/ /OAF/BARNSTABLE
LOCATIONtl� 7 it f� l`7 /b JiLd SEWAGE # o?600-3V
VILLAGE ` U 70 l ASSESSOR'S MAP & LOT,Q2 S�-On 7
INSTALLER'S NAME&PHONE NO. �
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) _ 02 � � d� (size) 13 k c2U
NO. OF BEDROOMS j
BUILDER OR OWNER MC'ALt Ca„1 n Gt�y^
PERMIT DATE: G_a 1-Z 00Q COMPLIANCE DATE: 3-1/-I �
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
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
OIL
F tit
Y� V 6n01
, E o lei
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Fire
TOWN OF BARNSTABLE
L ATION D SEWAGE #grams ���(s
I
VILLAGE C Aull- ASSESSO S MAP& LOT -,00 -00r
INSTALLER'S NAME&PHONE NO.����h2. \r>hXIN gn-gsoo
SEPTIC TANK CAPACITY /5610
LEACHING FACILITY: (type) - -Clnam6ers. (size) SOO 4'a
NO. OF-BEDROOMS 3
BUILDER OR OWNER
PERMITDATE: 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
,won 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
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63
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No. THE COMMONWEALTH OF MASSACHU ETTSAf-
FEE, ) %
BOARD OF EALTH jf /
' V
OF
APPITJPN FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application fora Permit to CUnslruet ( -141pair ( ) Lpgrade ( ) Abandon ( ) - Complete System ❑Individual Components
/\' ry 1{_�,7(1L/�y/�
I!/ U eJ ` ' i ' aw vim'-`
Owner's Name
^ Map/Parcel H Address
f ul N ( ( Q _ I'Icphuncjh
� + - �a fiv_Ldl� INe/,lYUll/ 1Y/��W`.�lY r
Instal o's Name Designers Name
Address Address
Telephone R Telephone N
Type of Building: Lot Size �J Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder ( )
Other—Type of Building No. of persons 1J Showers ( ), Cafeteria ( )
Other fixtures
Design Flow min.required) ��5 gpd Calculated design flower gpd Design flow provided 255 gpd
Plan: Date I d vn Num_er of sheets Revis' n Date
Title Q-u U
Description of Soils) ��� ��iC�wi "-3l`�LL l4��r. cLul �4_ A 5/A v2 '
Soil Evaluator Form No. Name of Soil Eva ator-0-SCLIA-LG6Lz� Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS
The undersigned agrees to install the above cipscribed Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further agree to e e s n operation until a Certificate of Compliance has been issued by the Board of Health.
Signed A-46 Date
Imo. °► ���'
FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
f
7.
N Zan¢
_ ;'No�.,�F09V-Vtf 7 THE COMMONWEALTH Of, MASSACHUSETTS FEE
BOARD OF HEALTH
OF: Y V
APPLIC�W
N FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a erupt to Construct ( 1Rcpair ( ) Upgrade ( ) Abandon ( ) Complete System ❑Individual Components
S uy�-
�. 1
i Luca iun Owncr's Namc
C4 In C) S c l 001-00
i Map/Parcel h Address
L`I7.i/ - YaYt f lephune
4 i " 'f' 14
Installer's Name T Designer's Name
Address - Address L
Telephone 9 - Telephone N
li
Type of Building: Lot Size �� Sq.feet
a-• .Dwelling—No.of Bedrooms Garbage Gri der ( )
is Other.—Type of Building No. of persons �� Showers ( ), Cafeteria ( )
- Other fixtures
Design Flow min.re,�quired)�gpd Calculated design flow �� gpd Design flow provided�gpd
I Plan: ate 0 .k—Ob Num er of sheets .� Revision Date
i Title
Description XSoil(s) t1� d� Yw-
Soil Evaluator Form No. Name( Soil Eva atom SO�M %G�t.G Date of Evaluation
DESCRIPTION OF REPAIRS OR ALTERATIONS -
The undersigned agrees to install the above d operaticribed Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and further �to e fke sm n on until a Certificate of Compliancehasbeen issued by the Board of Health.
Signed agreeDateow
FORM 1!- APPLICATION FOR DSCP DEP APPROVED FORM 5/96
t, �
—.-- .,__----,_—_-- - -------.----
j NO. !ti 6' jk? SI / THE COMMONWEAL H OF MASSACHUSETTS FEE /90 V.24'�,
1S .�alt BOARD OF HEALTH
'
--s
CERTIFICATE OF COMPLIANCE _
r,. Description of Work: ❑ Individual Componenf(s) : ❑Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),:Abandoned( )
by: \. /
at
has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built
plans relating to appli a .. ` ated 4erw ° 4 r 2 'f'Approved-Design Flow (gpd)
1..
Installer
Designer: Inspector GN.!/ _�_ Date'. 9� y
The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.
FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 -
r No!G► � •✓ f,J THE COMMONWEALTH OF MASSACHUSETTS FEE
►t ,, ,•� BOARD OF HEALTH
DISPOSAL SYSTEM CONSTRUCTION PERMIT
_ Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage
disposal system at ,wc if— -,Al)//6 as described r
in the application for Disposal System Con'sf"ruction Permit No. ?(o( — 171 7 dated
shall e completed within three ears of the date of this er•= it. All local conditions must be met.
Provided: Constructions a b
p Y � � p ��
Date --f `� I f wa r{1 , Board of`Health �Gy( C6tlI
FORM 2 - DSCP DEP APPROVED FORM 5/96
FORM 1255 (REV 5/96) (SW) HOBBSB WARREN TM PUBLISHERS- BOSTON -
r
TOWN OF BARNSTABLE
IoI" 7
LOCATION e6 l 1 � SEWAGE # 02�0-3V
�
VILLAGE G�� f ASSESSOR'S MAP & LOTD25L 11-& 7
INSTALLER'S NAME&PHONE NO. ��1►i� S r'"
SEPTIC TANK CAPACITY 00
LEACHING FACILITY: (type) (ai p►y.r��lf (size)
NO.OF BEDROOMS
BUILDER OR OWNER �^^� Q-
PERMITDATE: G ra 1—Z-vao 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
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
j A
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A 023-F Gi bC-
A F 01
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G- E !q
Q- F- a6
Town of Barnstable Pft G
Department of Health,Safety,and Environmental Services
Public Health Division Date 2-3-bo
367 Main Street,I lyannis MA 02601
s e,►nNan►aM
nuas.
rtcru���� Date Scheduled 2— Z 3 — C. o Time 9 c C' Fee Pd. Noo
Soil Suitability Assessment for Sewage Disposal
Performed By �lJ� t � r Witnessed By: yd`r"r
LOCATION & GENERAL INFORMATION ':
Location Address �j �dr�k ,��`� Owner's Name MCS\WA P_ -}-,
Address
Assessor's Map/Parcel: (�{(� Zr�" pQ,tiCgA ()C-7 .p07 Engineer's Name
NEW CONSTRUCTION V` REPAIR Telephone N 1 - .L1-Z_ u
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body It Possible Wet Area R Drinking Water Well ft
Drainage Way III Property Line It Other n
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
qa '
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Ilole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DCTERMINATION V SEASONAL:IIIGH�VATETt.TAT3L
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles:
Depth to weeping from side of obs.hole: in. Groundwater Adjustment Il.
Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
PERCOLATION;TEST Date x 2 o� Th' 9 /o
Observation
I lole N Time at 9"
Depth of Pere Sy Time at 6"
Start Pre-soak Time Q Q / V Time(9"-6")
p
End Pre-soak I 2 U
Rate Min./inch .4 Z
Site Suitability Assessment: Sile Passed t/ Site Failed: Additional Testing Needed(Y/N)
Original: Public Ilealth Division Observation Hole Data To Be Completed on Back
Copy: Applicant
DEEP.OBSERVATION MOLE LOG Bole# !
Dcp1h from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
%
�^oq »t loylz
G 34 r a t.%Ct YJZ
s�G
C sW 1eYk 7/,f
ma
DEEP OBSERVATION HOLE LOG :
Depth from Soil Ilorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure.Stones,Doulderes.
0
0 -12. 4w 1.04w I-ve 2!L
►2 -5/� l3 s..../ /oy2 s�G
t� o /. d4 wy �/
C S I ,6/ 1vYR4 -3
i1(o �I rKo/N
DEEP OBSERVATION HOLE LOG..: : 1I01e#''
Dep1h from Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes.
%
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnlcture,Stones,noulderes.
%
Flood Insurance Rate Map
Above 500 year flood boundwy No_ Yes t/
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 pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? y{J
I f not,what is the depth of naturally occurring pervious material?
Certification
1 certify that on (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 Z-'L 3 - u ej
1 /
N/F
TOWN OF 8,4RNSTABLE
17.289 .:
U.P.
� 'r
cA
-A ` y
o \,
44-7 l
o Z--:
A PEA S CJMMA R Y
� 1
D ZI
LOTS rn
UPLAND; 267, 713=&S. F. 6. 15--kAC.
WETLAND; 0*S. F. O�AC.
TOTAL; 267, 713-*S. F. 6. 15=kAC. 2.8.8 %
ROADS 116, 189 -bS. F. 2. 674AC. .12.4%
OPEN SPA CE '
UPLAND; 514; 568-+S. F. 11 . 81 AAC.
IG P� rn
WETLAND;. 32. 116�5. F. 0. 74�AC.
TOTAL; 546, 684-*S. f. 1Z 5 AC. 58.8% ��
TOTAL. 930_,586tS. F. 21 . 37 l00%
rG-aS
i
�G• OPE,'V SPA CE
UPL A ND=132. 818tS. f
WETLAND=O#�. r.
TOTAL=.132. 81p4.q. F
'594.7!'
17l
N/F , N/F
'h RAYMOND R. B NE AN'
RODGERS SOUZA 1
S YS TEM PROFILE
NOT TO SCALE
TOP FNDN. FINISH GRADE
FINISH GRADE' ��� -r FINISH GRADE OVER DIST. GRADE OVER OVER TRENCHES
• ••'►•;; DIST. BOX � Q. Q
' •a;a SEPTIC TANK
o,a 0
12" MAX.
e'f•�: e ••. :'f9: :od'�°G'•A•t!'?0'::p,ei y�.�•v. op:ebb:•:•' '• .e ti•v.•. w 0
e OUTLET PIPE LEVEL TOTAL LENGTH OF TRENCH
.o•.o'•P •p
3 -
0 FOR 2 FT. MIN.
4a�.opa
A.Q,1;•�: '4 ,� :p ® q _ 0�• . '• ,: •.O:a .•D..: •o' ':d• b" . ..e A. br la I
b p010
.D: 0 0 / 7C.�Q ® �• �: :D..'9.`O:. •:b`.:°.;Q•.. .Q Q '•} .'.)C {�d Q
C. I. OR PVC TEES --y o o oKooOl�
p
v. r
07.
.c p.••o.o. � , I i
►� .?500 GALLON D,I'•S TRIrBU TION BOX
BSMT FL .
Ao
EL . e�'-�- :%o�:;� ,: 0 500 G,4 L L®N DFI YWEL L S
PRECAST CONCRETE INSTALL ON LEVEL BASE
ti
0 p $j H-10 REINFORCED
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w o "�en:.ad-e;Q o 0'.*!00 :P a oR�•A.1#��iiADdS.�`...e4 a.,bj.:
S "P TIT C TA NK TRENCH ,SECTION
INSTALL ON LEVEL BASE NOTE: EXCA VA TE TO EL EV. OR
LONER TO REMOVE ALL IMPERVIOUS �lR
MATERIAL BENEATH THE LEACHING AREA 4. DIAM. —� 12 MIN.
REPL A CE EXCA VA TED MA TERIAL NI TH 3" OF J/g"-1/2 of
CLEAN. CLA Y FREE SAND WASHED PEA STONE
•o•
3140 — 1-1/2" WASHED " �°q•
FOA CRUSHED STONE :a$
GENERAL. NOTES TRENCH WIDTH
1 . ALL EL E VA TIO.NS SHOWN A RE BA SED ON BSC GROUP NUMBER OF TRENCHES 1
..�
'4'-10. s -"`" 2. ALL PIPES IN Tc-lE, S YS TEM ANUS T BE CAS T IRON NUMBER OF ORYNEL L S
� OR SCHEDULE 40 P Ic. OBSER VA TION PIT
3. THE BOARD OF f��IA.L TH MUST BE NO TIFIED
:;� WHEN CONSTRUG-7,GN IS`COMPL E T E PRIOR 9 ' 2
TO BA CKFIL L ING PERCOL A TION RA TE.'
�cs 4. ANY CHANGES .IN THIS PLAN MUST BE APPROVED <5MIN./IN.
cp0 p O BY THE BOARD OF REAL TH AND CAPE 6 ISLANDS WITNESSED BY*
SURVEYING CO., INC.
? DONNA MIORANDI
" 5. MATERIALS AND INSTALLATION SHALL BE IN
�G
COMPLIANCE WITH THE STATE SANITARY BARNS. BRD. OF HEALTH DESIGN ,D,4 TA CODE - TITLE V - AND LOCAL APPLICABLE DATE• FEE. 23, e0—
' RULES AND REGULATIONS
zap 6. NORTH APRON IS FROM RECORD PLANS AND NUl - Z NUMBER OF BEDROOMS 3
IS NOT TO BE USED FOR SOLAR PURPOSES A w 71111 �O
ti 1o,. 1 ,�„ a /u y1[ GARBAGE DISPOSAL
ti ti e is 1.7. .FL OOD HAZARD ZONE C (NON-HAZARD,I Q --.- ______ •z DA IL Y FL ON 0 GAL .
8. WA TER SUPPLY TOWN WATER L a �'r s` `�i V, / 1/� 1500 GAL .
� � z SEPTIC TANK RE® D.
�G '- ____ ________._ ,�, SEPTIC TANK PROVIDED 1500 ' GAL .
y � LEACHING REQUIRED 330 GPD.
aN -,�r
SIDEWAL L AREA = 152 S.F.
Msot ..^� 1525. F.X O. 7*/S. F. = 112GP0.
BOTTOM AREA = 329 S.F.
L.EGEN ,oy ray 32 .F.X 243GPD
' L EACHING PRO VIDED = 355 GPD
— o PROPOSED EL EVA TION �---
LOT 7 —�d -- EXISTING CONTOUR SINGLE FAl► IL Y RESIDENCE G
OBSERVA TION PIT
13, 879 SF. ® DISTRIBUTION BOX
e., PROPOSED SEWA GE DISPOSAL S YS TEM
r------� TRENCH }
PREPARED FOR
•s9 ,r ,:
FO-51 SEPTIC TANK MZ71,
NE CONS TRUC T1 ON
RESERVE AREA L O TORES T HILLS DPIVE
BARABLE—COTUI T—MASS.
c 7 PIPE IN V / ! ��� '�`"\�
EL E A TION
SXNK,Kl DA T 2c�,
PLOT PLAN � � A „ �� J CAPE 6 ISLANDS ENGINEERING
SCALE.• s "� o " � - op 7- ' G�sr� �}�f+ SCALE AS NOTED B00 FALMOUTH ROAD — SUIT 01
MAP SEC PCL L 0T HSE �' s PLAN NO.
MASHPEE, MASS. �8
DVAMRIMT 81145s e _
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