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HomeMy WebLinkAbout0145 FOREST HILLS ROAD - Health 145 Forest Hills Road Cotuit A = 025 007015 WN t1�J� y5 TOWN OF BARNSTABLE �L LOCATION l S SEWAGE # Z000-(ft{ VILLAGE CO ASSESSOR'S MAP & LOT aS- 007-o/S INSTALLER'S NAME&PHONE NO. �7(_--ioS l SEPTIC TANK CAPACITY /S6� LEACHING FACILITY: (type) C'.L" (size) �® NO.OF BEDROOMS 1 BUILDER OR OWNERCC �e �►�� G`�� e on PERMITDATE: UD COMPLIANCE DATE: �I��//U 2 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 i �-30 t No.< �< �� THE COMMONWEALTH OF'' MASSACHUSETTS FEE BOARD OF HEALTH �qU 61 OF ��'nIj lit- APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( y/Repair ( ) Upgrade ( ) Abandon ( ) Complete System ❑Individual Components Location / Owners Name 0D Map/Parccl H Address I_ol N 'relc hone N Inslallcr's Name Designers Name Address Add ess �hl -7 "b Telephone 8 Telephone# Type of Building: Lot Size1 Sq.feet Dwelling—No.of Bedrooms 3 f ,Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. required) J� gpd Calculated design flow -330 gpd Design flow provided Z6 gpd Plan: Mate -DD Number of sheets I .Revision Date Title 4 ""- -, AQj Description f Soil(s) a-tic �L(,,i�tt_ b y �. ' tint LWA:--A, I I- O" r (— Soil Evaluator Form No. Name of Soil Evalua or` UAA-C- u: Date of Evaluation E '0 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe I n to pl the system ipoperation until a Certificate of Compliance has been issued by the Board of Health. 1 Signed ---- \CS � Date jr ir FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 I No. �7T THE COMMV C1VWEALTH OIk�IVNASSACHUSETTS FEE e`er"t�- BOARD OF HEALTH YAPPLICATION o F FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for Permit to Construct Repair ( ) Upgrade ( ) X• andon ( ) ' ]/Complete System ❑Individual Components Location +a.,..>., Owner's Name i q 1 f ` Map/Parcel ft Address 1 I" •:._ j Lol it z 'I ebl hone a r L t . Inslallcr's Name Designer~Name Address - ( - Add css t Telephone it ` Telephone if Type of Building: 4 Lot Size 14 Sq.feet Dwelling—No.of Bedrooms,_ t � Garbage Grinder ( ) Other—Type of Building No.of persons U9 Showers ( ), Cafeteria ( ) Other fixtures Design Flow�-,m•iyn�.quired J J gpd Calculated design flow 330 gpd Design flow provided gpd Plan: Date _N.umber of sheets �_ Revision Date `Title Description f Soil(s) ��9•` �UCLIt LP � 1 U Soil Evaluator Form No. Name of Soil Eva ua or`9 s u�- Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS t r Th'I ndersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furthe g es no gl_ the system��`ra6ocn until a Certificate of Compliance has been issued by the Board of Health. SignedDate Miens - D FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 NO. � THE COMMONWEALTH.OF MASSACHUSETTS FEE W BOARD OF HEALTH V �.� CERTIFICATE OF COMPLIANCE Description of Work- ❑ Individual Component(s) '6@mplete System The undersigned hereby certify that the Sewage Disposal System;Constructed epaired( ),Upgraded-( ),Abandoned( ) by. has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design " lans/as-built plans relating to pplic—alion No. dated Approved Design Flow_2 (gPd) Installer Designer: Inspector �"'. Da ` / 4 // I The issuance of this certificate shall not be construed as a gua ntee that the sy tam will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.-ZUw" y/ THE COMMONWEALTH OF MASSACHUSETTS FEE 0P,L4_µ-)d" _- BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereb ranted tQ Construct (f.�Repair ( ) Upgrade _( ) Abandon ( ) an individual sewage ' disposal system atN � �l lZi����d+•r�~ as described in the application for Disposal System Construction Permit No. Z�y—yy9 dated �llrr� Provided: Cons uction shall be completed within three years of the date of this pgrrmt.All 1!�dltio U;?t bt. Date Board of Health <i/ FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) Ho H&W eBs i WARREN'm PUBLISHERS- BOSTON O . 1' r TOWN OF BARNSTABLE CC SEWAGE # LOCATION C►` l S 'S MAP & LOT VILLAGE C® r ASSESSOR 2,S'' Otl7��S INSTALLER'S NAME&PHONE NO. �- ' ° � ??(o—5©S�{ SEPTIC TANK CAPACITY ,19-60 LEACHING FACILITY: (type) c ;na pr` (size) NO. OF BEDROOMS �M BUILDER OR OWNER I 1`c PERMTTDATE: 00 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 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 F 4 GaAAcE. 2 �3= 301 �� - 43 i ^� _— �;1 /► Q� � alit iii=i� � .�: .��� �� I. i. • - A t•JE"ice��- ' �.I I� - �p • D - © Idr e _ a Town of Barnstable PN { Department of Health,Safety,and Environmental Services HE Public Health Division Date 2-3-bo 51, 367 Main Street,I lyannis MA 02601 6ABNaTAarB, t . Date Scheduled Z Z 8 — CD O Time Z Fee Pd. �(7d Soil Suitability Assessment for Sewage Disposal Performed By.,DO-L) t d .> YLt A l� Witnessed By: /,�D if N4 _,44/d r 9+N C/ LOCATION & GENERAL INFORM T$ON Location Address Fdr�� `�``� Px' Owner's Name Mn e��,� � /'//• `6��''%,����� �`'x" Address `-'� . Assessor's Map/Parcel: (��e pA1gA OC 7->J� Engineer's Name NEW CONSTRUCTION V REPAIR Telephone 9 Land Use to eo tat' - Slopes(%) S 76 Surface Stones Distances from: Open Water Body R Possible Wet Area R Drinking Water Well tt Drainage Way R Property Line It Other It SKETCH:(Street name,dimensions of lo(,exact locations of test holes&perc tests,locate wetlands In proximity to holes) Sal N CL a o Parent material(geologic) O ✓¢�+ 1 t l Depth to Bedrock Depth to Groundwater: Standing Water in I lole: Weeping from Pit Face Estimated Seasonal Iligh Groundwater .... ................_.............................._................................... ..........,........... .......................-............................. ........ .. t O . J O I- . t' t .'.:i. Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hole: in. Groundwater Adjustment (1. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level PIi,RC'®IAA IOI�1I+.5 ' 1(eiee :Tilde Observation I tole H Time at 9" i Depth of Perc Sf; Time at 6" 3a Start Pre-soak Time© 2- Time(9"-6") End Pre-soak Role Min./Inch Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) i Original: Public Ileallh Division Observation Hole Data To Be Completed on Back--� Copy: Applicant DEEP.OBSERVATION HOLE LOG Mole# 1 Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Uoulderes. % k s DEEP OBSERVATION HOLELOG : Hole# ..Z Depth from Soil I Iorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Uoulderes. % G - /o o4 � � 0 2 f •1iG/tom � �1a✓S�..�/ /o /? �� DEEP OBSERVATION HOLE] LOG ` `" Hole Depth from Soil Ilorizon soil'rcx1urc Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Uoulderes. % GLAIdL- DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Ilorizon soil'rcxture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Struclure,Stones,1loulderes. u Flood Insurance Rate Marl: I Above 500 year flooJ boundary No_ Yes Within 500 year boundary No v Yes Within 100 year flood boundary No v 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? ye r i If not,i what is the depth of naturally occurring pervious material? ertification I certify that on "— (date)I have passed the soil evaluator examination approved by file 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. Si nature Date —28—e`o N/F `� q TOWN OF BARN STABLE L'.P. Go O AREA S CJMMA R Y LOTS a' UPLAND, 267, 713-kS. F. 5. 15-kAC cq WETLAND; 0#S. F. O-*AC. TOTAL; 267, 713-*S. F. 6. 15-�AC. 28.8 % N , ROADS 116, 189 AS. F. 2. 67-4AC. 12.4% °t ,,'��• OPEN SPACE ' UPLAND' 514, 568�S. F. 11 . 81-4AC. .' ��,P��� WETLAND; 32. 116-*S. F.. 0. 74�AC. � . ��, . TOTAL; 545, 684�S. F. 1�. 5�AC. 58.8% ,;� a to TOTAL. 930,566$S. F. 24 . 37 100% -2 �G- OPE,'V SPACE .d GP ' UPLANO=132. 818-*S. f WETLAND=,O$f. r. TOTAL=.132. 8?f?tc. F 594 S'3 .;8 17"1 N/FI N/-F RAYMOND R. a IRENE ANTONE f RODGERS SOUZA S YS TEM PROFILE NOT rO SCAL E TOP FNDN. FINISH GRADE EL . .6 716 FINISH GRADE ro 7. o FINISH GRADE O VER FINISH GRADE OVER O VER TRENCHES ry g.5 �.oPeo SEPTIC TANK G©. O DIST. BOX ♦4.0. 12" MAX. 00:44, �....e::� �j; ;pC'4�.Dyypt:Q,o�pOe:vo o/a.YAppi4.di .e'bb. »r 1� TOTAL LENGTH OF TRENCHZ5' �o 'o'•Pe 0 tt V d. .•�o:p. .! . , .. . OUTLET PIPE LEVEL 3.. .Q a FOR 2 FT. MIN. p •a:evi O ;o Oo0 D o0 P q e oi• . '•w: .0;� D: ' d• :b v o• bca. 0 O y O•�'�� al ®e :I: 6•r q ':p; o .a� "Ab �Oe •� .a ae oo .;,o.de p' r77.'78 9 ae f•:n.e�e:. •;b•::l:e.: o •. .. . .. . . g4 0 db C.I. OR PVC TEES REMOVE ALL A B B UNSUITABLE MATERIAL NI THIN 5 T. I q' °.? °•: e' '' OF LEACHING FACILITY AND REPLACE NITH CLEAN SANS o 1500 GALL ON bo drS TRIBU TION BOX BSMT FL . EL can. 3 0 „500 GALLON DR YWEL L S "e y o INSTALL ON LEVEL BASE a o, PRECAST CONCRETE .o. . 4Qpa.'e b _H=__10 _:AEZ•NFOPCED 6: .Q.�,•e)o:an.d,:,,o'.bp'e'•peb':O�b::a•p'�'QYQ Vpo:�'E'c'0'' °4'�r;'� .e. •..o,.v • .p• .p O..e:.i. .O'PrLOb, :4 � p.Q: Ba.00 TRENCH SEC TION SEP TIC TANK INSTALL ON LEVEL BASE NOTE' EXCA VA TE TO EL 'V: Tom•6"± OR LOWER TO REMOVE ALL IMPERVIOUS ' MA TERIA L BENEATH THE LEACHING AREA 4" DIAM. I R" MIN. REPLACE EXCA VA TED MA TERIAL MI TH a p: 'o', b• 3" . OF 1/9"-1/2" Q , CLEAN, • • • o•.b . ;o,.'Q;A �r � LY A Y FREE SAND � � � ' WASHED PEA S TONE 1p 3/4" _ 1_1/2„ WASHED ti; oN t �.• • � � CRUSHED STONE ;.� , „ o •. d �. : E : 54 0 N � 6•� .49, . GENERAL NOTES TRENCH WIDTH 54.3s �y 1. ALL EL EVA TIG"AS SHOWN' ARE BASED ON NUMBER OF TRENCHES 1 2, ALL PIPES, MUST BE CAST IRON SER c-�^y a-c DR o •vJ Nia rVE'LLS 2 OR SCHEDULE 40 PVC. OBSERVA TION PIT N 3. THE BOARD OF HEAL TH MUST BE NOTIFIED — P-9675 WHEN CONSTRUCTION IS COMPLETE PRIOR TO BA CKFIL L Dl G PERCOL A TION RA TE.- 4. ANY CHANGES .rN THIS PLAN MUST BE APPROVED <5 MIN,/IN. � BY THE BOARD OF HEAL TH, AND CAPE 6 ISLANDS WI TNESSED B Y• SURVEYING CO. . INC. DONNA MIORANor L O-� _15 5. MATERIALS ANi) INSTALLATION SHALL BE IN . �\ COMPL IANCE W PTH THE STA TE SANITARY BARNS. BAD. OF HEALTH DESIGN DA TA CODE - TI TL E V - AND LOCAL APPL ICABL E DA TE: FEB. 28, 2000 t vo RULES AND RE�:ULA TIONS #• 2 3 Z ''��N• o o _ NUMBER OF BEDROOMS •�Ao,y 6. NORTH ARROW S FROM RECORD PLANS AND w0 -- r���' GARBAGE DISPOSAL NO �•o IS NOT TO BE USED FOR SOLAR PURPOSES (o" °� z v Ida �_ -- 7. »FLOOD HAZARD ZONE C (NON-HAZARD) �' �o" ___LOU1 z - 330 GAL . DA IL Y FLOW «. 8. WA TER SUPPL Y - 5&NDY _LOQw•t _ _' " SANDY-LOW SEPTIC TANK PEG 'D. 1500 GAL . �T 60 36 ' 1500 GAL . ice' _.:.IoY � C SEPTIC TANK PROVIDED — y.1�izDtO�ED `� LEACHING REGUIRED 330 GPD. ALL •A- B -B- UNSUITABLE MATERIAL NITHIN 5 FT. OF THE LEACHING` FACILITY IS TO j BE REMOVED AND REPLACED NITh CLEAN SAND p I U i I l5dw12 j Ss52WALL ARE74 152 S. F IOYt- IoY12 S F. X G/S. F G BOTTOM AREA - 32-9 S. F.—� L EGEND 32s o. T.�--- 243 S. F.X G/S.F. = GPD N a 0�lNI7W� 120, 1�10: 12DUNOWA'T� — —355 — LEACHING PROVIDED — GPD tiGD PROPOSED EL EVA TION TING XIS CONTOUR SINGLE FA MIL Y RESIDENCE C (1 y• a 3SERVA TION PIT to 22' 2 I� OISTRIBUTION BOX ?z--� "�'"=_�" `-- A ^�� PROPOSED SEWAGE DISPOSAL SYSTEM � . TRENCH ' , to PREPARED FOP. 0 0 ,SEPTIC TANK .aP MCSHANE CONSTRUCTION 70 6 6 - _ ` ` LOT 15 FOREST HILLS DRIVE DESERVE AREA • BARNS TABLE—COTUI T MASS. S , !2I M OF I?P&93. SPUD PIPE INVERT ELEVATION ,. r,Av EC. �2.fX7' r , - DA ;rE. . JULY_ y7 20CX7 -_. ,-era+�;��► �� � .- - ,r u, - - CAPE 6 ISLANDS ENGINEERING PLOT PLAN SCALE AS NOTED 800 FALl�101/TH ROAD — SUTTF ��0.. - SCALEi - .. .^ V p� -./�• I`..0 ♦ • l_. A 0 o ...+, rw,..+.•.t..^* .-. E...