HomeMy WebLinkAbout0102 LEWIS POND ROAD - Health 1Q2 Lewis Pond«Road
Cotut !
TOWN OF A TABLEti
LOCATION ` SEWAGE#. Q 6��
e
VILLAGE SS SSOR'S MAP&PA CEL l ®'" II
INSTALLER'S NAME&PHONE NO. i
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) . on^, (size)
NO.OF BEDROOMS
OWNER Q -
PERMIT DATE: t'J COMPLIANCE DATE: Q �9
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
q.:
Oak
TOWN OF BARNSTABLE
`LOCATION W 15 R000( filf/ SEWAGE #
' VILLAGE Ca7-411 T ASSESSOR'S MAP & LOT �Q
INSTALLER'S NAME&PHONE NO. /V1 k44411,4
SEPTIC TANK CAPACITY A104e
LEACHING FACILITY: (type) (fr,<sP001 (size) 8OO.pO
NO.OF BEDROOMS . _5.
BUILDER OR OWNER
PERMITDATE: X 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 leachinn facilii Feet
Furnished by .=�'� �14;Gs
l/ '
i
T I
. 1
I
of
L<<SSPGa�.
A
r 100
No. DD ; ' ,r Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION a TOWN OF BARNSTABLE., MASSACHUSETTS
ZiVVjiration for Mi5vo5al *pgtem Com5tructiun perinit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components
Location Address or Lot No. jo-Z lTt�is P 0?4D ao Owner's Name,Address and Tel.No.
Caryrr
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. ,?ASta(tS jfC VAT1 Designer's Name,Address and Tel.No. LA14DISQ$ -CAU LS',
P.a 184 11TZq P a B* 3(04
r-CXZbS7DAZ �12 -�t3a-0 l a ta>.P•to�,-c1� ��s ,y SHr�_ i?3 3
Type of Building:
Dwelling No.of Bedrooms -3 Lot Size 2Z 17-0 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow .336, gallons per day. Calculated daily flow '3'a allons.
Plan Date '7• /2 Number of sheets Revision Date 9
Title
Size of Septic Tank c� I Type of S.A.S. C;y1�l�IS
Description of Soil JIL-AN cS61
Nature of Repairs or Alterations(Answer when applicable) 915PJACJS EA I MD ` O-PI ,
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 prolie
'Ale 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bey is Board of Healt .
Signe Date 6' C�Application Approved by _ DateApplication Disapproved lowing reasons
Permit No. Date Issued
No. !! r:` ;. _ Fee * {/
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
.j Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppYication for Migaaf 6pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or.Lot No.` GZ t lzl,;a t5 +I'6 R R 5 2� �pN� t1Q Owner's Name,Address and Tel.No. � G
CcrL rt .
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. PASTMZ ZkcAVA,C"I V Designer's Name,Address and Tel.No. L.A1-+Db2 S -CA J t_s�-
P,o 804 1Z°9 P.G B 3(o
r_C)R657DAL �Zp - P(36o W, r'aL.Mol,MA 0257y 514o - 7753
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size 7-F I7-0 sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
! Other Fixtures
Design Flow 356 gallons per day. Calculated daily flow gallons.
Plan Date '7- /7- Number of sheets ? Revision Date 9'Zey U
Title
Size of Septic Tank Type of S.A.S. CF//9"A #_S Z
4
Description of Soil PLAt-j '56)l^ t-C
i
Nature of Repairs or Alterations(Answer when applicable) K1WLAG.' TA(LIS D CSSS 9 0-0 a—
4
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 provis�n ' fP le 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has bee is d y is Board of Healt .
%, Signed %i !fl �,c /10 t�i-, Date
Application Approved by l I�1/ i r V ff ! Date V
r Application Disapproved for the following reasons r 1 m
07 7
Permit No. I Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (. ) Repaired ( )Upgraded )
Abandoned( )by PAST6m [;XE-AV A)_1 61J
at O Z LrS� S C P C,1 V t\ h Pleen constructed in accordance
with the provisions of Title 5.and the for Disposal System Construction Permit Nov a dated
G _ 1Designer2 k
Installer A TcNL C 1 S' GAe1 ,Nr
The issuance of this permit shall not - c rd guarantee that the sysl unotti/o,. s es m d.,
Date �� '� Inspector t/ 1�
v �
- No. / //) — Fee
THE COMMONWEALTH OF MASSACHUSETTS
f PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
xi5po5al *pgtem Con.5truction Permit
Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( )
System located at I UZ- uR X.S PC%,0 ' _ +�T1 t`x`
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 a co ' leted 'thin three years of the date of this perm, r
Date:_._ Approved by
}
Oct 20 08 07:38a John Cauley '.508-540-3344 p.2
, 1 .
Town of Barnstable
Regulatory Services ;
Thomas F.Ceder,Director
AM Public Health Division
_Thomas McKean,Director.
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-?W-6304
Installer&DesigneX Certification Form
Date: 10 I -0 Sewage Permit# Assessor's MaplFartei Za l
Designer. ctrlrkv Vs�\�:P Installer:
Address: 21�� Address:
(b,;eOt i megjh' ',
On 'was issued a permit to install a
(date) (installer)
�
septic system at Icy s�:,:3'� ► �c�i �r�. based on,a design drawn by
(address)
dated �'1 I'� C S rc e.� h Z.4�Oe� ,
(designer):
1, certify that the septic system referenced above'was installed stzbstantially acCording to
the design, which may iaclude iminor, approved changes such as lateral relocation of the
distribution box and/or septic tank
I certify that the septic system referenced above was instaUed with,major changes (i.e.
greater than 10' Iateral relocation of the SAS or any vertical relocation of any compon nt
of the septic system) but in accordance with State&Local Regulations. Plan revision or
certified as-built by dcsigtaer to follow.
'•+'•
sta is Signatur
n ,
rgner's Signature) (Affix Fyn�&ir's Stamp Here)
Vr T N. RTI C TE OF
COMPLIANCE WILL N B UED UN OTH THIS FORM AND AS-B i -CARD
UQEMD BY YAL HARNSSTA, LE MAUF.NALTII DDURON._T-HAn- YOU.
Q:14.cahh1ScptclDc3igncr Curt ficadon Form 3-26-04.doc
Town of Barnstable P#
h_
Department of Regulatory Services
oF,ME r. Public Health Division Date-6 eff
200 Main Street,Hyannis MA 02601
i se»xsreer e f�.
9� MAB& ,6g ii oo
PtfDMAt� Date Scheduled 3,Jv-T D09 Time Fee Pd. 1�
Soil Suitability Assessment for Sewage Disposal 7o M
Performed By: V QGfovt� Witnessed By: PA
1G. (o.�
.... ..._.......__...._...............................................:..........................r..:. ..... .N
y I :I
... ..................:�::/�. �� .:...i .. ... �. r .... .i'.
Location Address ,r.,:..._
Y �.� Owner's
Address %o z-
oo
Assessor's Map/Parcel: 0-2.0 /� t Engineer's Name I �p
( Vt1,t-ice L.iLµ+!pi�•16b� �E !�
NEW CONSTRUCTION---.____...REPAIR Telephone#! S- 40-
Land Use , Slopes(%) p a Surface Stones I�L r- UtdaS n.ttey g
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well 4 ft
Drainage Way ft P i �-g y Property Line � ft Other 8
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
T``►
i — — sj�� , A
I
Parent material(geologic)C_6V1! 9z SJ Depth to Bedrock ii A .
Depth to Groundwater:. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater ` 201
' .5..........::!:::!:P!i,i!!!'!''�'r•:!i�.._m:--::.rae::c:�: .:::��: .:=:..m:-r.:r ..:::��-:.n_r.:::,::.:, ,..,.,,;.x..
t..,,.._.^I-.....u...__....... ....... ..!, r ... ,..:.!.:._...:::- .. .. I r:,.,....,:: .a.....r;....!...,..,,r.....-..._,..,!,.I:r.:...:,.,.,...,.!x:.::_..,......,.:.!.:.a:.,:urr..:_.:
qntgr
.:.. .. ........I ..... .... .. ............. .... F� I.
:.................u.....,:,..,..,:........._:........r.........:....:,............................:::::::::,::::.........:..........,,:....::,,.:r.:.:,:::::::::<•,::::.......r......._._..._.,......:......:..........:...:.,....,.,._..........,::�::r....
Method Used:
-- - - Depth Observed standing in obs.hole:._- in. Depth to soil mottles:
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
■n1•'��.. ... :����.��''�� ;:,;:-�:::I; :.t: :13:atp.............?lii:. '�xirite!:_
r.i..._ .._,,.:•,.I!!!::::�::::I:r:.u::::::::...:-...:.,....,...r.,....i._.............,.......�.�........................ ...:..:�:....!I......:......_.........::.,.I..v......::.,.............r, {" :::i........ ...:........:......._v.^6,.:__.i,. I I
Observation
Hole 11 Time at 9".
tt
Depth of Perc �a Time at 6"
Start Pre-soak Time @ Time(9"-6") /
End Pre-soak to yrNi"1
Rate Min./InchrJyri .
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) K)
Original: Public Health Division Observation Hole Data To Be Completed on Back----=---
Q:HF.ALTH/WP/PERCFORM
Depth from Soil Horizon Soil Texture Soil Color Soil Ofher
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
01A It,
N
° .(n
RSER��TIQ�:.H.�.L�.L.�.G:,.:.,: :::::•:::::.:::.H.ole::.#::;:>:::<<:»::::<:::>::::>-��:<::«:<::.;;;:.:.:.;>:�..r::
Depth from Soil Horizon Soil Texture. Soil Color Soil Other tV
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones, oulderes.
° Cn
0
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistenpy.%Gravel) -
.r;:::.:. ;:5.;..f�::.:::.: Other
Depth from Soil tiorlion Soil Texture Soil Colo o
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes.
Consistency,° Gravel)
Flood Insurance Rate Maw /
Above 500 year flood boundary No— Yes 11
Within S00 year boundary No—
Within Yes
Within 100 year flood boundary No L/ 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?
If not,what is the depth of naturally occurring pervious material?
Certification {-
I certify that on IS (date)I have passed the soil evaluator examination approved by the
Department of En ironmental Protection and that the above analysis was performed by me consistent with
the required training,expgtise and xperience described in 310 CMR 15.017.
Date,
Signature _._ �• 0e
a
Oc
93
I BK 210 LOT 5 A SC 00 STR ET
Al
I I 280.24. AFTER ROAD TAKING r�
�T I '"'N 12°5000 E 27.2.00 (ORIGINAL PLAN DISTANCE)
wiz Y ,
CD BENCHMARK: �
I ; CORNER OF D CK� 1
I I ELEV. 108.80 EXI TINGI o
I �
II iv 105- \ LEACHING
I ' C I \\ IT 'If0 BE'% /
II BEDROOM \ MOVE;D ANT)
\ I POSEED OF,.
cn 30
DECK 5 --- -- CO 1 �' // i I , 1
I . ,
I \` BA. �o OD E /rn 4 1 co
BA.
11 6
LOT 4 0
I -�---J LIVING NOOK i i �. i \� 1 '7' I '
I -- ITCHE 1'�
r' I I 1 \ ► , �' 28,120f S.F.
EXISTING 3 2.
BEDROOM
o, HOUSE
1 IRST FLOOR BY , oS R 1 '
FRONT DOOR / t i i
1 ELEV. 106.82 cn / A;"E
8' -------- O '
0
TpV2 T 1
PAVED
C\2 DRIVEWAY
S 12°50'00" Yr 281.01' (ORIGINAL PLAN DISTANC +)
` 2%'8.03' AFTER ROAD TAKING SITE PLAN
QE ^ PREPARED FOR
off 9� STEPHEN HEMBERGER
U EY � OF
\� \ LOT 3 A � 102 LEWIS POND ROAD
0.3s101 `�� BARNSTABLE, MA
TT J. E. LANDERS-CAULEY, P. E.
,. CIVIL ENVIRONMENTAL ENGINEERING
0 10' 20' 30' 40' P.O. BOX 364 WEST FALMOUTH, MA 02574
508 540 — 3344 fax
SCALE: T" = 20' ASS. 20-011 DATE: 07 17 08
LOT 2 A SCALE: 1" = 20' DRAWN BY: JDR
REV.09 24 08 -TT) JOB NO. 1777 SHEET: 1 OF 2
MAGNETIC TAPE SHALL BE. INSTALLED ON ALL COVERS INSTALL OBSERVATION PORTS ACCORDING TO TITLE 5 STANDARDS
F.F. ELEV.=106.82 BRING COVERS TO "WITHIN 6" OF FINISHED GRADE r
ELEV.= 104.5 20'MIN.
{
4" CAST IRON OR CONCRETE COVERS ELEV.
SCHEDULE 40 P.V.C.
4" CAST IRON OR
DIST.=30.5' scxEnuL.E ao P.V.C. 12"MIN.
3" LAYER OF
pzz
SLP._ MIN SLP.= 0_005 ELEV.= 97 2 1/s"-1/2"
INVERT CONCRETE COVER DIST.—1��_ WASHED STONE
EXISTIN DIST.=24:1_ SLP.=0.01 0"0"0"0 0"0"0"0"0"0"0 0 0"0"0"0"0"0"0"0"0"0"0"0"0"
* FLAW LINE _ INVERT o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o c
pELEV.= 98.00 _0_0_0_0_0_0_0_0_0_0_0 0 0 0_ 0 0_ 0 0 0_0_
LEV.=_ io" MIN. 19" o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
* THE SLOPE OF THE ELEV = 97.75 ®®®® 0 ®®®® OOO�OgO00gO00v0� 24" LAYER OF
THE LENGTH OF ENV = 97.51 ELEV.=97.34 0 0 0 0 0 0 ®®®�®®®®®®® o 0 0 0 0 0 o /4" To 1-1/z"
PIPE AND INVERT ouTLET TEE is g O O O O O O O ®®®®®®®®®®® 0 0 0 0 0 0 O C`WASHED STONE
DETERMLIC0 BY THE 4" CAST IRON OR O O O O O O O O O O O O O
P//' OUT OF THE BASEMENT LIQuro DEPTH OF SCHEDULE 40 P.V.c. DISTRIBUTION BOX o O o 0,0 O ®®®®®®®®®®® o„O„0 0 O„O„o
THE TANK USED. ELEV.= 95.28
SHALL BE FIELD (SEE CHART AT RIGHT) IF MORE THAN 4' OF COVER.
LENGTH OF 2 0 4' 10" x 8' LEACHING CHAMBERS
VERIFIED PRIOR TO LIQUID OUTLET TEE USE H-20 aLOADING
INSTALLATION OF TANK1.500 GALLON SEPTIC TANK DEPTH BELOW FLAW LINE TO BE WET TESTED IF USE STONE TO EQUALLY SPACED IN A 5.8'
4 FEET........14 INCHES MORE THAN ONE OUTLET 12.5 x 25.0 BED.
.
TO BE PLACED ON 5 FEET.......19 INCHES LEVEL THE BED
6" OF STONE OR 6 FEET.......24 INCHES TO BE PLACED ON AS NEEDED. l
MECHANICALLY COMPACTED SOIL. SEE 310 CMR 6" OF STONE OR _ - - - - - -- - - - - - - - - - - - - - - - - - - - 1 _
15.227 (6) MECHANICALLY COMPACTED SOIL. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV
USE A TANK WITH THREE COVERS.
USE H-20 LOADING SOIL TEST DONE BY. J.E. LANDERS—CAULEY P.E.
IF MORE THAN 4' OF COVER. WITNESSED BY: D. MIORANDI ---------------
PERCOLATION RATE: __2---MIN/INCH P# 12293
7- TEST HOLE- 1 DATE: 0 Alt? 08- ELEV._99_5
PROFILE OF I CERTIFY THAT I AM CURRENTLY APPROVED BY THE
DEPTH HORIZON TEXTURE COLOR MOTT. OTHER DEPARTMENT OF ENVIRONMENTAL PROTECTION PURSUANT
SEWAGE DISPOSAL SYSTEM - TO 310 CMR 15.017 TO CONDUCT SOIL EVALUATIONS
0"-10" /A/E LOAM AND THAT THE ANALYSIS GIVEN HAS BEEN PERFORMED
NOT TO SCALE BY ME CONSISTENT WITH THE REQUIRED TRAINING,
EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR
15.017. I FURTHER CERTIFY THAT THE RESULTS OF
MY SOIL EVALUATION, AS INDICATED ON THE ATTACHED
SOIL EVALUATION FORM, ARE ACCURATE AND IN
GENERAL NOTES: ACCORDANCE WITH 310 CMR 15.000 THROUGH 15.017.
10"-32" B L AMY SANI 10YR .5/8
1. THIS PLAN IS FOR THE REPAIR OF AN EXISTING SEWAGE DISPOSAL SYSTEM.
2. PLAN REFERENCE Bk 210 Pg 93 LOT 4 BARNSTABLE REG. OF DEEDS.
3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM
AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. 32"-120" C ED. SAND 1oYR 6/4 DESIGN DATA:
4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. NO H2O
TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS ENC'D
FOR THE SUBSURFACE DISPOSAL OF SEWAGE. TEST HOLE 2 ' DATE: 071�08_ ELEV._101.4 NUMBER OF BEDROOMS
5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN GARBAGE DISPOSAL �I911E_(9�_-___
6 OF THE FINISHED GRADE. DEPTH HORIZON TEXTURE COLOR MOTT. OTHER
6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE I TOTAL ESTIMATED FLOW 330----- GPD
SAME, UNLESS NOTED BY FINAL CONTOURS. 0"-10" /A�/E LOAM
7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE ; ( 11(Z__ GAL./BR./DAY X -3---- BR. )
OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SEPTIC TANK CAPACITY QQSL9L__
P�, �pF ��
SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING " ``� q� LEACHING AREA REQUIREMENTS
AREAS UNLESS NOTED. U "_32" B LOAMY H �`'
8. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL a 10 SAN 10YR 5/8 'i vp
S- ULEY Y � SIDEWALL AREA �50.0_ GAL/S.F.
BE MORTARED IN PLACE.
9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH ` 3 01 BOTTOM AREA _=-5 __ GAL./S.F.
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO ° ' T. ; ' LEACHING CAP.(BOT. & SIDEWALL)_ 342.3 GAL
OBTAIN SUCH DETERMINATION FROM APPROPIATE AUTHORITY.
10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF / 32"-120"- C 1 ED. SAND 10YR 6/4 \> y
ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. H2O RESERVE LEACHING CAPACITY _342_3 GAL,
ENC'D
1 APPLICANT: STEPHEN HEMBERGER DATE: 07/17/08
REVISED: 09/24/08 JDR SHEET 2 OF 2 JOB # 1777