HomeMy WebLinkAbout0123 SCHOOL STREET - Health -t?3 SCH-00I COTUIT
TOWN OF BARNSTABLE
;:+)CATION-41J PC11a17Z _;r, ����T _. SEWAGE#a00"02
VILLAGE C��^���T ASSESSOR'S MAP&PARCEL � l
INSTALLERS NAME&PHONE NO. . i Z t1&4We4,f'-
SEPTIC TANK CAPACITY 45 l
LEACHING FACILITY: (type) ool le-'-t") (size)f 3
NO.OF BEDROOMS . -3
OWNER ® �
PERMIT DATE: 9 o��'- �� COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility z Feet
Private Water.Supply Well and Leaching Facility(If any.wells exist
on site or within 200 feet of leaching facility) i Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) / Feet
FURNISHED BY � iG? �
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No. s y Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipprtcation for �Dioogal �&raem Con0truction Permit
Application for a Permit to Construct( ) RepairX Upgrade( Abandon( ❑Complete System ❑Individual Components
Location Address or Lot No.-IZ11 ` C1111VG'.e PIP- Gt+7-0—i Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
i��d� C �®�'(/f ��� 6 �1�,� Lt.d't!O® Ps': i �f'f(s1✓r ot,Is..
Type of Building:
Dwelling No.of Bedrooms `� Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building 4%r! P— No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) �° gpd Design flow provided J:vro gpd
Plan Date P Number of sheets Revision Date
Title
Size of Septic Tank '� Type of S.A.S.
Description of Soil
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 B d of Health.
Signed VDate
Application Approved by Date d '�- -
Application Disapproved by: Date
for the following reasons
Permit No. Date Issued
� "..`� t . .fir✓' .r.�.a.,� �-�,,...ia`wf; r.`.u'�.:+.�aC .. ,ayr+�+*r!4�.+._ a�'alfio,�'SLY;i�/',+A'"+.�iF'r�1.r�"'..7+..!CFkFy�"h��rs Si^-Y'9M'+n' 'Y+ c _ .. ,�
No. _ i Fee
THE^COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes r
1 ,
f 20plication for �Dizpoal *potem Con0truction Permit
Application for a Permit to Construct O Repair
tlO Upgrade O Abandon O El.Complete System ❑Individual Components
A t
— Location Address or Lot No*j' +j fCX1oc-C P2- ZPX_/ Owner's Name,Address,and Tel.No.
Wes.Assessor's Map/Parcel �� 110, °
i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building: t
ate^
Dwelling No.of Bedrooms Lot Size _.sq'`ft. ,Garbage Grinder ( )
Other Type of Building ,-V OV= No.of Persons 1 Showers( ) Cafeteria( )
Other Fixtures ^
Desi -AT]ow(min:required) gpd Design flow provided s �'O gpd r'
Yan Date P Number of sheets Revision Date
Title
Size of Septic Tank J W ����f Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: t,
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 Title15 of the Environmental!Code and not to place the system in operation until a Certificate of
Compliance has beer issued by this B rd of Health.
/ J
f Signed '... Date
Application Approved'by r \3 Date ` '- - -
w Application:Disapproved by: e`` ,, Date a
. r for the following reasons b '
PermitNo.Q0 1)q " Date Issued
! —————————— ————————
r THE COMMONWEALTH OF MASSACHUSETTS
I
BARNSTABLE, MASSACHUSETTS ,
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (,/) Repaired ( Upgraded ( )
/Abandoned( )by /3
I at C'yTG/T has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. "�-4 dated
IInstaller i� C����y _ Designer <:5,4'y/•O .6 0,eV-0✓ 0eP,
#bedrooms Approved desi now gpd
j The issuance of Is t shall i of be construed as a guarantee that the system action as .sigune
i
f Date (1� Inspector / � I
f ------- --- -----� -- ------- d ———y f—i-----1--
No. Fee �� a
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
xi.5pogal �&p!gtem Cow5truction Permit
Permission is hereby granted to.Construct ( � Repair (d!)'ZUpgrad��'�
) Abandon ( )
System located at '� �G.l�ao0
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.
ProvidednConstructi n must be completed within three years of the date of thisNlikm,
Date �J i Approved by
r �'�
Oct 23 07 03< 20P p. 1
'down of eir.11 stable
Regulatory Service
Thomas F.Geher, Director ,
� Public Health Division
% a< rf°
Thomas I�Icc.I{ an,Dtrector
200 Main Street,Ryanllis,MA 02601
Offlice..508-462-4644 Fax. S09-790-6304
Installer &Desizner Ce2'laifacation-F'oran
Date: Uj J
l eai ere A\/I ,IfIst-Oler>
Address: . 7 l6VWqL004 Address:' ��(�'�11
`....... -
Oil�l7-67 C was issued a pennit to M-
elate installer
septic system at__I-2� c based on a design drawn by
(adddress)
dated
(designer)
_ 3• certify that the septic stern referenced above was installed sub s -
P y d . r,tlnta�lly a.000Td1r1�; to .
-7.he design, which may include minor approved changes such as lateAl velocation of the
distribution box and/or septic tank.
I ccrtify. that the septic system referenced above was installed with' a�i or changes
greater tfizm 10' lateral relocation of the SAS or any vc r icatrelocation of any comportcilt
of the septicssystern)but in-accordance with State &Local RegdIations, Plan rev,isiola Or
certified as-bi It'by designer to follow.
J �� ID
(litstaller' Signature) -- -- MASON
-w
No.n
elSTE��®
Sq�ITAR\�'�
(ll ier s.Signature) (Affix e gner's Stamp Here)
PLEASE RETURN TO BAR STAR1.K PUBLIC HEALTH Dr , SION. CERTIFZCATF
OF COldtPLIANCE WILL NGT'Ji .;SSUED IA II®Tki •THIS I�'O�1'� Al�lf� �S-
BUILT CARD ARV,RFCE I3 ly-.T•RF, I3sl..STAULE I'l[71.3L (;RED Xl; DIVISI®1�T
T-RANK YOU.
t2: �[calr}�/SepticL[)csit ncr C Crtiiication Form
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Town of Barnstable P#
Department of Regulatory Services
Public Health Division Date o>
ss �� 200 M in Street,Hyannis MA 02601
Date Scheduled : Time Fee Pd.
Soil Suitability Assessment for Sewage Di nosal o Q ,
Performed Bv:s/" tY�� 1 �''` `"-i Witnessed By;
LOCATION& GENERAL INFORMATION
Location Address reloloo,z _r7 Owner's Name
C �O T Address
Assessor's Map/Parcel: 0a4r ^®y/ Engineer's Name fO_-(4/ezo _���
NEW CONSTRUCTION REPAIR Telephone#
Land Use 12f,161M 1 v Slopes(%) Y!2 Surface Stones
Distances from: Open Water Body_�ft Possible Wet Area=ft Drinking Water Well ft
Drainage Way _ft Property lane 7 t V ft Other $
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
• r .
o a
C
- K1Y
CD m
CC) 1%
w r--
CD M
Nam► ,
Parent material(geologic) W I W � Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face
Estimated Seasonal High Groundwater r
DETE RATION 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 , TIM
Observation
Hole# Time at 9"
Depth of Perc Time at 6".
Start Pre-soak Time @ Z ot. / Time(9"41
End Pre-soak t !s
Rate MinJinchJL
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:ISEPTIC\PERCFORM.DOC
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DEEP.OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
cConsistency.% ravel
t
Gt /oil b
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color soil-, , Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.% ray
�4 �IL
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency,
Flood Insurance Rate Map:
Above 500 year flood boundary No-Yes -_:,.,.,,
/r •
Within 500 year boundary No Y
Within 100 year flood boundary No_ Yes
4
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the
area proposed for the soil absorption system? ��
If not,what is the depth of natura ly occurring per ious material? r.._._._.._,.
Certification
I certify that on ` (date)I have passed the soil evaluator examination approved by the
Department of Environ ental Protection and that the above analysis was performed by me consistent with
the required training,expe ' and.expert ncp described in 310 CMR 15.017.
Signature Date
Q:\SBPTI0PERCFORM.DOC
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Cotuit Fire Department T U
Fire, Rescue & Emergency Services G� j�
�t corim 64 High St. - P.O. Box 1632
/
19i6 '�� Cotuit, MA-02635
Paul A. Frazier Phone (508) 428-2210
Chief of Department FAX (508) 428-0202
TO: Tom McKean, Director of Public Health
Town of Barnstable, Board of Health
P.O. Box 534 -
Hyannis, MA. 02601
FROM: Chief Frazier, Cotuit Fire Department
SUBJECT: Tank Removals, et al
DATE: December 23, 1998
The following tanks have been removed/abandoned since my letter dated September
15, 1998. If you should have any questions or need additional information, please feel free
to call. Thank you.
NAME ADDRESS DATE NOTES
Johnson 209 Raiyn Rd. 10/30/98 1000 gal. tank removed,
Cotuit, MA. 02635 no contamination or odor
present.
Moore 33 Putnam Ave. 11/08/98 500 gal. tank removed,
Cotuit, MA. 02635 no contamination or odor
-- present.
Brown 123 S-ool St. 11/12/98 500 gal. tank removed,
Cotuit, MA 02635 no contamination or odor
present.
Pappalardo 176 Cotuit Bay Dr. 11/24/98 500 gal. tank removed,
Cotuit, MA 02635 no contamination or odor
present.
Mikutwizz 59 Point Isabella 12/15/98 1000 gal. tank removed,
Cotuit, MA 02635 no contamination or odor
present.
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ASSESSOR'S MAP NO. e�'2-0 PARCEL olv
LP'CATION � 23 �dL SEWAGE PERMIT NO.
VILLAGE
C �
IN ---A-M E S S
8 U I L D E R OR OWNER
D A T -
IS-Su Ew
DATE-
rt2N,s►1 �� �' ) ,
S ize
call
Q�
Sys�c°�
s��mS moo.
two ra,�
I
ASSESSORS MAP :
_ EST HOLE LOGS `
. PARCEL : ��/ NOTES:
-.• SOIL EVALUATOR : 9 AVi P M A L�..
( us {� FLOOD ZONE �./t� T- l ,`mac.{��C'�8,� ,
WITNESS : o lk1:,- � E to
REFERENCE: „....a _._,..._ ~ 1) The installation shall comply with Title V and Town of Barnstable Board of
DATE � .I J ���jto health Regulations.
-�" h PERCOLATION RATE: -Z M I 2) The installer shall verify the location of utilities, sewer inverts and septic
\)J/ ` ►�.' ,, ��j components prior to installation and setting base elevations.
TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first
two feet out of the d-box to the leaching shall be level.
t 4 This plan is not to be utilized for ro crt � line determination nor an other
r � ' �DN ) P p 1 5 y
�I ---�-- purpose other than the proposed system installation'.
�o4m W� 5) All septic components must meet Title V s ecifications.
1 1/--� p
t" "� ��0 6 Parkin shall not be construct v r i-
g constructed o e ..I10 septic components.
LOCAT I ON MAP C� ;�", 7) The property is bounded by property corners and property lines.
tit"), j y� 8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms .o be considered for design. Receipt of
i°'-��, ( payment for the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
9) The existing leaching or cesspools shail be pumped and filled with material
__. ';2 37,` per Title V abandonment procedures. Those within the proposed SAS shall be
removed along with contaminated soil and replaced with clean washed sand
per Title V specs.
—' 10)System components to be 10 feet from water line. Sewer lines crossing the
i
water lime shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
�- -- , S E P T I C, SYSTEM DES I G N applicable.
11 If a garbage grinder exists it is to e removed) g � g b and is the responsibility of the
a FLOW ESTIMATE owner to ensure such..
? �� 1.2)The installer is to take caution in excavation around the gas line if applicable.
1
BEDROOMS AT ( (Ca GAL/DAY/EIEDR00M _7 bGAL/DAY The installer shall verify the location, quantity and elevation of the sewer lines
exiting the dwelling prior to the installation.
SEPTIC TANK
I jMGAL/DAY x 2 DAYS - ' GAL
USE i5COGALLON SEPTIC TANK
SOIL ABSORPT ION
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- I DE AREA: ZX, Z� -}- t 2'� t 1 Ia`�,52
BOTTOM AREA: z 1 ?( -7 Z
'ff I M - - -I , -, SEPTIC SYSTEM SECTIONJA i
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X,�Gl-1 M P-12
Ali o C>2 C)p 1'ou.too9l
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----. - - �'� 1 10 1� 2'` d�3,/�'�`ice�� ! o �i 5'�cL}G ,3� x� X ,
i \ µ•me ��� , r�ewcqrrzoO y
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oC� GAL `t�'
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... ? SEPTIC TANK
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S 1 TE ANDS SEWAGE , PLAN
LOCAT I ON : — I Z .1-Icx
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PREPARED FOR
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SCALE:
DAV I D B . MASON,"R.,,; DATE:
DBC ENVIRONMENTAL' DESIGNS
z EAST SANDWICH . MA!
3 DATE HEALTH AGENT
z ( 508 ) 833- 2177