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Home My WebLink About1065 OLD POST ROAD (CT & MM) - Health ;,.-1065 OLD"POST;,ROAD . A 074='003 001 -- - -- Cofuit Town f Barnstable P# Departmed`of Regulatory;Services. MWgrA . Public Health Division Date z639.A 200 Main Street,Hyannis MA 02601 Date Scheduled 2 Time w1 Fee Pd. 00 Soil Suitability Assessment for SewagLisp Qsal D Performed By: ��fGlUj ° /� i �C6�Witnessed By: HS / t LOCATION;& GENERAL INI+'O.RI-ATION Location Address D 0 rq p6s n� Owner's Name �k J�e f K Address 119 Or 40 C�-I�• �- Assessor's Map/Parcel: f r Q 7 0(13 0 ( Engineer's Name NEW CONSTRUCTIONvREPAIR Telephone# Land UseSID& Slopes(9Yo) ` � Surface Stones Distances from: Open Water Body ��O ft Possible Wet Area ft Drinking Water Well ft Drainage ay ft Property Line 2®ft. Other ft KETCH:(Street nam a sions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I r lot% O 5 Parent material(geologic) �ffl �/ � Depth to Betitaalt •�2 Depth to Groundwater: Standing Water in Hole: MONF Weeping from Pit PA0e Estimated Seasonal High Groundwater ' DETERMINATION FOR SEASONAL RIGH WATUR 'TA]��,� Method Used: Al"" Depth Observed standing in obs.hole: In. Depth to soil mottles: _. _ in, Depth to weeping from side of obs.hole: _ - in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj,Uroundwater Uvel PMkC0tAT10N BEST >ait�. Observation Hole# Time at 9" Depth of Pere . ' Time at 6" Start Pre-soak Time @ �'0O Time(9"-6") A! , End Pre-soak Rate Min./Inch ''Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within.1001 of wetland,you must first notify the Barnstable Conservation Division,.at least.one(1) week.prior to beginning. Q:\SEPTIC\PERCFORM.DOC, . DEEP OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture Soil Color Surface(in.) ) (Munsell) Soil (USDA) Other ) Mottling (Structure,Stones,Boulders. Consistency,%Gravel - g /LG A/cwE' Look DEEP OBSERVATION HOLE:LOB Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Surface(in.) Other (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel /2-32 B 32 J3� G MF��I a� t DEEP OBSERVATION HOLE I�OG Hole# R Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) _ Mottling. (Structure,Stones,Boulders. Consistency,%Gravel yip-P/t kI OM FR/ 4 646? .3t>►leg �i �yE N1� l�ri� �fj �' DEEP OBSERVATION HOLE LOG :Hole# Depth from Soil Horizon Soil Texture Soil Color 'Soil Other Surface(in.) (USDA) (Munsell) M4ttlin g ,(Structure,Stones,Boulders. Con istenc o Gravel) o-5 r d. !o -30 ,B Lo �ti /oyip 8 s, i• 30/�8' 4 E; v ,e Flood Insurance Rate Man: 250�/ ®�$'� A-7/6c/ u7vl - Z Above 500 year flood boundary No_ Yes / 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 pervio s material exist in all areas observed.throughout the area proposed for the soil absorption system? . 45 . If not,what is the depth of naturally occurring pervious material? Certification I certify that on �9 (date)I have passed the soil evaluator examination approved by thei Department of Envir tal Pro d that the above analysis wasp performed by me consistent with the required tr ' ng, lr 'sea ce described in 310 CMR 15.017. Signature Date Qi\SEPTIC\PERCFORM.DOC. t �. TOWN OF B RNSTABLE , �� 6� LOCATION � SEWAGE # VILLAGE e"'�d7-S)12E ASSESSOR'S MAP 6z'LOT 107y 6o 3 INSTALLER'S NAME & PHONE NO. -��_ �eu� UffZ� SEPTIC TANK'CAPACITY ` 6-D cl�� p" LEACHING FACILITY:(type) C- ,`4_ ) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ` s DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: "7 VARIANCE GRANTED: Yes No � �v�1 r u l 6 . r . i p_ 003 Fas...3(:�>........... THE COMMONWEALTH OF MASSACHUSETTS AMMEo BOAR® OF HEALTH - Bcnea Catiw�Department TOWN OF BARNSTABLE �-, 2-d a- anc>� ltrtt i tar iripmial Warbi Ton.itrnrtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair (L-100an Individual Sewage Disposal System at: . ------------- -------... ......................................................... Lo at inn ddrrss �� t No. Own d r s a -------------�t� -try Wiz_ Q�b� Qa .._ '�f - ------------ - --------------- -- - ---- --- Installer Address Type of Building / Size Lot.................... Sq. feet t-� Dwelling— No. of Bedrooms------------------------_----..------.....Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------- ----------------------------------- -----------------•---- ---------••----•--•-----...--------- W Design Flow.. ....5-75-......................gallons per person per day. Total daily flow....... .(10....................gallons. lx Septic Tank-1—Liquid ca acity JS gallons �engtl......�...--- Width---------------- Diameter.........:-..... Depth................ W Disposal Trench--No. .... .� 3. Width Length...f..... Total leaching area....................s ft. x � � - g q. 3 Seepage Pit No-------------- ---- Diameter...............--.-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 94 ----••--•--------------------------•----•--•--------------------•--•------._....--------------------------------.------......-•---------•••-------- ---•-- 0 Description of Soil....................................................................................................... ---------=--•---•--------------------.......----................ x U ....................................-.................................................................................................................................................................... w --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------••--- V Nature of Repairs or Alterations—Answer when applicable............................._.................................................................. ---------------------------------------------------•----..........•---------.....-----------.........---••--------------------------------------------------------•----...................------....---- Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersign further agrees not to place the system in operation until a Certificate of Compliance has been ssu ar of h th. Signe .... .. . ... ..................:....... Dare Application Approved BY ................................................... .............. .... .... . Eure Application Disapproved for the following reasons: .................... ....... ............................................-- ............ ------.............. ...................... ....... .........................- . . .. ........ .............. .. ..................................................................._........ ...................--................... lDace Permit No. ........C1 . �..�... .............. Issued ............... e- ........ �� ......... Dare _w�l�-+.�v'.�""_^..-✓v..-.�tir""".v�.�,�.r+y:...,,1..:n.�4j r•._.+r. ..�r....---...ti.,..[._rr�-..�ti„r.....+.°..'- 'ti�' -- w r c. „ v- •,yv,._..-. ..-•--. No.. Fas.. � ...'`_ THE COMMONWEALTH OF MASSACHUSETTS' p ... -BOARD OF HEALTH TOWN OF BARNSTABLE ' ApPra#iun for Diripw3 al Ourkii Towitrnr#ion Prrmi# Application is hereby made for a Permit to Construct ( ) or Repair (L--<an Individual Sewage Disposal System at: PAD ° .........: ......................................................... _ Lo•at!"I Address /^ _Or,,Irot No. p . ............A._ I.JI r ................. -- •• __ -�.._.. ......................... Installer + Address < Type of Building / Size Lot............................Sq. feet ►, Dwelling—No. of Bedrooms-..-........---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ..................... ...... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------ W Design Flow.. ..._---�-------------------------gallons per person per day. Total daily flow....... ........._..........gallons. Septic Tank' 'S I_igInd cap gallons Length.... ....... Width--------------- Diameter--- ............ Depth................ W Disposal Trench--No.��Yf.- S.. Width.................... Total Length...% C ......-. Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-----------.-------- Depth below inlet..................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-------- -------------••----•..••••-••--...---'••-•---•--•-----•-••---.... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.-- r-14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -------------- •-••-------------- --------- ••••--------------- •------------------- •----------- 0 Description of Soil........................................................................................................................................................................ U W -••-•-••--------------------------------•------•'•--......._........-•--------................••••----•---....•----------------------•-----.........•--•----------..._.........................•--..... V Nature of Repairs or Alterations—Answer when applicable............................................................................................... -••••----------------- ..................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of has &ssued_by-the board of health. Compliance been Signed:...': w1�'.................... - mil - --- .. . -..... .......... ` r q Dace Application Approved By ------------ -..... ... .......'.......................... . -.. . . ...................... ....� D - _ ..-..��' +'�,� Date Application Disapproved-for-the following reasons: ..... .................................... . ...................... ....._................................... .............................................................................................................. ...........................------............----------...._.-----------................. .............._........................ Date Permit No. - .1®.- ......_.......... Issued ............. ...�.. .......�.....�....... .........^.....:.:............. Date :. ——— ---.`---=,c..-,y�.c_�T.:��. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Clelrr#ifirate of C�om}�Iittrcre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by 0.-' =-.. s-ro-_i..t..c...m= _..............- �.. at .... ................ 7 .......................................... '--...........:.--------"---"r"�L..,,. l�s.. ..._ pp p _ _ _ has been installed in accordance with the provisions of TITLE 5 of ate e St Environmental Code as described in � the application for Disposal Works Construction Permit No. yy dated .. ............... ... ........ ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 1CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... .` ... .....R.. 5 ..l.................... -------- Inspector ----- --------:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE . :No... . FEE: : ........... �t��g��a1 nrk� �un�tra�ilan �rrnti� Permission is hereby granted........ _ °" =- _-A --- 3` A=�.: -.lam................ to Construct ( ) or Repair (�_-)-an Individual Sewage Disposal System at No.................................... .- - Y Strcet �� as shown on the application for Disposal Works Construction Permit No.......:............ Dated...............................-........... 1 Board of Health DATE..-------e7. �,-�---`--1- -�--••---••---------•--•---------------•- i FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS „ �- TOWN OF B RNSTABLE i LOCATION � `� SEWAGE # — VILLAGE ASSESSOR'S MAP & LOT p INSTALLER'S NAME & PHONE NO. V SEPTIC TANK CAPACITY ��Cv i LEACHING FACILITY:(type) L.,t c i� Q. (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �c-I-k-A--- DATE PERMIT ISSUED: `-1 ',L�L DATE COMPLIANCE ISSUED; '7 - VARIANCE GRANTED: Yes No l el f