HomeMy WebLinkAbout0285 PINE RIDGE ROAD - Health 285 Pine Ridge Road
Cotuit
A= 018-109
4 TOWN OF BARNSTABLE
LOCATION 2$S 9inc R,jq c RJ, SEWAGE# ZOI y - 33`7
VILLAGE C,4c,;} ASSESSOR'S MAP&PARCEL ##12 - 109
INSTALLER'S NAME&PHONE NO. JR F, R CXQaVcLA i O.J
SEPTIC TANK CAPACITY /000 90L)
LEACHING FACILITY: (type) Trcncl•CS ('Z) (size) Z X 3 x 33
NO. OF BEDROOMS 3
OWNER r, S , S
PERMIT DATE:��G-1 y COMPLIANCE DATE: f D- 3- I y
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
Al - /D•Cv ' r
REAR
A3-e�7S A d3
�3_I/P7 �ii O
3 y �,
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No. O (4—L—o7 Fee [�O�
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0(pplitation for Misposal 6pstrm ConstCuttion Permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.2 /ne id? O is Name,,Address,and Tel.No. 4
Assessor's Map/Parcel C0�1 — 10 N e15 " - f�l o 15 -5 Of-53
Installer's Naipe,Address,and Tel.No. Designer's e,Address,and Tel.No.
t(� �XCdVahon 569- 44 77-,6653 Z,8C vl ron men,c� 509433�-.Z/7
Type of Building:
Dwelling No.of Bedrooms �3 Lot Size ♦ G�p sq.ft. Garbage Grinder(Alt)
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures 7�,
Design Flow(min.required) 3 0 gpd Design flow provided _3 S� gpd
Plan Date �� Number of sheets { Revision Date
Title- St fit 'f �e 1✓
Size of Septic Tank X 1660 Type of S.A.S.
Description of Soil
A9_d 5ac�Ad
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 Certificate of
Compliance has been issued by this Bo alth.
rbiKed Date 9—11—
Application Approved by 1Tk1flVWV11 Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
_-_=_ - -
If
No. ao 1 Fee l
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
0[ppliCation for Misposal *pstem' ConstrUrtion Permit
Application for a Permit to Construct( ) Repair(vUpgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.z/� S ne id tip eQ O er's Name,Address,and Tel.No.
C DTU1 Q 012 !' N c-hv/S -509'S3
Assessor's Map/Parcel — f�1-L �0
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Z3ta �XCQ✓afion 5 6 9- 4/ 77-0453 � r �1 aon rnentC-- ( 509-k33 -217
Type of Building:
- Dwelling No.of Bedrooms o O Lot Size O(e sq.ft. Garbage Grinder( ) L-)
Other Type of Building � No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow-(min.required) r , 33 D gpd Design flow provided gpd
Plan Date /� Number of sheets Revision Date
Title 6)It + 5ewoce 0/Q n
s' Size of Septic Tank(') Type of S.A.S. I V1< Q e
Description of Soil
_fit 5a" r-
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 Certificate of
Compliance has been issued by this Boar ' alth.
r ed. / _ / Date -W( 14
Application Approved by Date #
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
--------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
} (Certif irate of CompYiattre
THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( )
Abandoned( )by 1.7 t 17 C(I V r 1 I n
at z�5 P,n ED C_OT Q has been con c ed'n ace
with the provisions of Title 5 and the for Disposal System Construction Permit No _ddt
Installer �1 h) P�1: 611 r_Fn V Designer �n y I r lJitl � r�
#bedrooms Approved desi ow 3 gpd
a
The issuance of this e it hall no be c nstrued as a guarantee that the system w'I ftm '• de" ed.
Date . Inspector
No. ) V/ Fee
THE COMMONWEALTH OF MASSACHUSETTS
,'T PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS '
Misposal 6pstet -CoustrUrtiott permit
Permission is hereby.granted to,Glo truct() Repair(7) Upgrade( ) Abandon( )
System located at ! I 0-e ( d (',�� C D � ) t-r—
�� f
and as described in the above Application for Disposal System Construction Permit. The applicant recognized h /her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:C gstruction must be completed within three years of the date of this permit.
Date Approved by ylf
i
Town of Barnstable
�T ' �� Regulatory Services
Richard V. Scali, Interim Director
* BAMSTABLE.
MASS. �0 Public Health Division
1639.
i°Tenrna�° Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: 2 Sewage Permit# Assessor's Map\Parcel
,q
Designer: 1 ��-� Installer: 47
Address: Address:
On �� �71 �W was issued a permit to install a
(date) (installer)
septic system at �� lU�� �1 , based on a design drawn by
(address)
tv 0+ dated Il Zd
(designer).
ertify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10° lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructed ' nce with the terms
of the IAA approval letters (if applicable) aGQy��OF
DAVI
B.
Installer's Signature) UTASONs
( g No.1066
41Vj ,R` `
(Desig s Signature) (Affix Desi ag. p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
Town of Barnstable P#
Department of Regulatory Services
`AMZ: Public Health Division DateMAM
� a7q. �� 30 ain Street,Hyannis MA 02601
Date Scheduled Time Fee Pd. V® A
La
Soil Suitability Assessment for Sewa P D a
Performed By: Witnessed By:
LOCATION&GENERAL INFORMATION_
Location Address - Owner's Name
�//��(�,,.y,,,��//�9�� Address v�-Ylcr�-KJV�
AsseCl MAp/Pz { "/lA Engineer's Name l
NEW CONSTRUCTION REPAIR Telephone# s%("r
Land Use Slopes(%) Surface Stones
Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SKETCH:(Street name,dimensions of to exact locations of test holes&perc tests,locate wetlands in proximity to holes)
•
o _
Parent material(geologic) Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
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 ft.
Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level
PERCOLATION TEST Date Time
Observation
Hole# - Time at 9"
Depth of Perc _ �)� Time at 6" -
Start Pre-soak Time @ Time(9"-6")
End Pre-soak -/ _ _ _
Rate MinAnch
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 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
r
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
1. •
1 /4
law
DEEP O SE_RVATION H_ OLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil . 'Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
1 if
DEEP OBSERVATION HOLE LOG Hole#
Depth from - Soil Horizon Soil Texture T Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel) '
.r
DEEP_ OBSERVATION_ _ _ _H_OL_E_LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other'
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate May:
Above 500 year flood boundary Now /dyes
Within 500 year boundary Ndlf/ Yes
Within 100 year flood boundary No Yes - -
Death of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pery us teml exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe ous material? v�
Certification
I certify that on l� -1 T (date)I have passed the soil evaluator examination approved by the
Department of Enviro ental Protection and that the above analysis was pe o d by inconsistent with
the required training,expert' expe e e described in 310'CMR 15.017
Signature Date 01
Q:)SEPTIC)PERCFORM.DOC
TOWN OF BARNSTABLE
LOCATION 1�0� Itj't, ��`Y — SEWAGE #
1VII.IAGE -T' ASSESSOR'S MAP & LOTDQ�
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) L (size)
NO.OF BEDROOMS
BUILDER OR OWNER QQMD-i'�J
&ATE: ikci L COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) 6J Feet
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within 300 feet of leachingfacility)
Furnished by 4
i
e �
� _ 11
� �� -
TOWN OF BARNSTABLE
LOCATION S ��-P SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO.SEPTIC TANK CAPACITY /0 091 &ni- ,
LEACHING FACILITY:(type) /00 6 &�f C (size)
NO. OF BEDROOMS_ PRIVATE WELL OR .PUBLIC WATER
BUILDER OR OWNER Ah., iPreg-, v
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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4
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V
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ASSESSORS MAP: I
8 _
- --- -- - TEST HOLE LOGS
PARCEL:
I I) The installation shall conii.:, witii'111113 V anLl 'Town of"Amt jloard o1.
- --- - ...--------------- -_.- -- _------- .- I lealth Itegulalions.
FLOOD ZONE: CS�' SOIL EVALUATOR: ,
WITNESS: mto I 1 67 2) The installer shall verify the location of utilities,sewer inverls :ind septic
REFERE110E: DATE: components prior to installation and selling hase eleva(icros.
(�.
PERCOLATION RATE: . 3): All gravity septic piping to be 4 inch Sell 401'VC at 1/8"per foot.The first
_.,G Z.U1'
. two lbet out of the d-box to the leaching shall be level.
YAl�i..� _-W�t�-1�, �_-ll l -)�� � �.� �p,, ��� �� I , , q) This plan is not to be utilized For property line determination nor any other
TI-1- I T -2 purpose other than the proposed system installation.
fJ � � 5) All septic components must meet Title V specifications.
6) Parking shall not be constructed over 1110 septic components.
/ 41 �0 7) Tile property is bounded by property corners and property lines.
e
The property owner shall review v w design considerations to approve of total
LOCATION MAP �? �� v1� �� , I {.�, design flow and number of bedrooms to be considered for design. Receipt
of payment for tine plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
per Title V abandonment procedures. Those within (lie proposed SAS shall
I b� be removed along with contaminated soil and replaced wilh clean sand per
Title V specs.
t ti' r7, UJI ZL�L7 ` , W •��� 10)System components to be 10 feet from water line. Sewer lines crossing the
•� IK water line shall be sleeved with 4 inch SC1140 PVC with ends grouted if
' L applicable. The proposed SAS is being installed below the water service
— � pP
line. The line is to be sleeved as aforementioned and maintained in place.
11) If garbage grinder exists it is to be removed and is the responsibility of the ;
SEPT I C, SYSTEM DES I GN
.� owner to ensure such.
12)The installer is to take caution in excavation around the gas line if such 1
6ZJ0 FLOW ESTIMATE 1
( -� (� � exists. ,
—- IL
13)•1'lie installer shall verifythe location, quantity and elevation of the sewer
BEDRUQF►fS AT GAL/DAY/BEDROOM -�GAL/DAY ` lines exiting the dwelling'prior to the installation.
ID 14)This plan is representative only that a system can fit on a property meeting
W SEPTIC TANK Title V requirements.
(� GAL/DAY x 2 DA S - GAL
\ \ USE 160D GALLON SEPTIC TANK 0t,15T1\04 r
a .42 SOIL ABSORPTION SYS EM
(1/J � � ►tom
J'
bAVIU �y
M e. u` 2 Z?C 3�_-t- ASOIV
S I DE AREA: ' tos
No. ti y
BOTTOM AREA:Z �3� �C O T tin
39) S I N ,T INS, ,
c ii7 S
S,_:EP_TIC SYSTEM. SECTION
$,�wG4* ,
UP vF guest
L iI _..
� �t1,31� ....
AAV
,b 1a_JjQy�" 02 tyrl�TC�l7 .-Bb � f t 1 f
�nDQ GAL y ►�(Erl. 3�1
SEPT) C TA14K c�t�i- y ��Gfl �,� s :1ZT
\\ SITE AND SEWAGE PLAN
LOCAT I ON : Z� PIW E, 9j'r
?,0 PREPARED FOR : t p YOV4
CALE: _
DAV I D B . MASON,i\5 DATE: it 2a
° DBC ENVIRONMENTAL DESIGNS
W
EAST SANDWICH . MA
Z
DATE I HEALTH AGENT ( 5 0 g ) 8 3 3- 2 17 7
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