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HomeMy WebLinkAbout0020 WESTBURY WAY - Health 20 Westbury Way -- Gotuit A 026 033 No. � / CrQ ` C 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYitation for Misposal 6pstetu Construction 3permit Application for a Permit to Construct( ) Repair Y) Upgrade( ) Abandon( ) ❑Complete System NJ Individual Components Location Address or Lot No. aD Wc-5TB jP Wi41( LOwner's Name,Address and Tel.No. CO�ueT jW RtJS�Cdt8C6 t- OVSrVCg /�t3TrfdFZo Assessor's Map/Parcel (5 d 3� l Smgg ST (-{YJ}lc/IdfS Installer's Name,Address,and Tel.No. 509-411 —9 SZ 7 Designer's Name,Address,and Tel.No. CAP& Jkt)E C�.dTl7WAj9eC, vt.C- N JA ` Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations((AAnswer 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 Board of Health. S' Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Do Date Issued 1 No. n_e) Q / Fee / o C) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatlon for DI8po8AY ,*pstrm Construction Permit Application for a Permit to Construct( ) Repair 'Upgrade( ) Abandon( ) ❑Complete System %Individual Components Location Address or Lot No. 20 WC_:5T&jr WAN-] Owner's Name,Address,and Tel.No. 7 r_Av%Z►J CO-fUIT SZ,48cr. !-fc�0v..)(:x Assessor's Map/Parcel (oR(0 033 i qG Sp--N ST' 1-FV4x/rl/5' Installer's Name,Address,and Tel.No. 508 -W71 —9SO-7 Designer's Name,Address,and Tel.No. Caocwtr�c- rr�u-lt�a.(s� ct.c. N 1A /S3 � .rA St MA-StEP ' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Nuniber•o sheets Revision Date Title ` Size of Septic Tank Type of S.A.S. Description of Soil z "+Nature of Repairs or Alterations(Answer when applicable) lam! C.r <_6 4-It uJ6 EfOU S 6 Tp Sc=P ri c— TA J K. t&te last inspected: Agreemen�!, 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 Board of Health. S' Date / Application Approved by• Date `7 7 5 Application Disapproved by Date for the following reasons Permit NO. ( Date Issued L� --------------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS C olv (j, BARNSTABLE,MASSACHUSETTS � �k (Certificate of Comptiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� z Upgraded( ) Abandoned( )by 0_I49Ry](i)9 C..Xl7EW?r2(5Zj5 , at PC) w�STe)Qy �{U ` cj-roI ' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No-_C/5—01 q dated Installer d4pc_w(D CAA GP-T OJSi 3 Designer #bedrooms Aj Approved design flow N� - gpd. The issuance of this.permi shall not be construed as a guarantee that the system will ncE n s designed Date C// 3 Inspector , r No. �C� 17 1 4 Fee 66 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem (Construction Permit Permission is hereby granted to Construct( ) Repair'(X) Upgrade( ) Abandon( ) System located at a0 6-S-r8! gl 4 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be -omplet d within three years of the date of this Cb, . - Date L( Approved �s No. C�00 Fee ` D. v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[ppYication for lgigooal bpgtem Cottgtrurtton i3ermit Application for a Permit to Construct( . )RepairX Upgrade( )Abandon( ) El Complete System individual Components Locati Adder;,or Lot No. Owner's Name,Address and Tel.No. Assessor's b"ap/Parcel a(o3,� I (o �;WT-Hj�4, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. k�C3cJQ.P6 �shs�r' 5Vr&e e.,;\j-vjc ,� Ian �3,ieS. 5tb- 5.8 53`} - 49(4 Type of Building: Dwelling No.of Bedrooms _ Lot Size Q IL)a�S__sq.ft. Garbage Grinder(N�fft- Other Type of Building N tsf')2 No. of Persons v Showers( 1,<Cafeteria( 'VY' Other Fixtures �.A�a7aD� 1Q,TuI c�ira�c L f �2y' Design Flow ® gallons per day. Calculated daily flow 3 P5 gallons. Plan Date 31,�9-1 Number of sheets Revision Date Title SNWM � Size of Septic Tank Type of S.A.S. Description of Soil C� Nature of Repairs or Alterations(Answer when applicable) -� p�C3sl 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 5,0 he Environmme ode and not to place the system in operation until a Certifi- cate of Compliance has been issued aq�d of Head . Signed Date Application Approved by Date U Application Disapproved for the following reasons Permit No. Date Issued L ,.b 5 \,, 7 •• � N j j� l J i`} No:' �` t� Fee l v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ., { ,, PUBLIC r HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS pplicatiou for 30iqu al *p.5tem Cottgtruction Permit Application fora Permit to Construct( )Repair><)Upgrade( )Abandon( ) ❑Complete System>Individual Components Location Ad�-ss or Lot No. � � Owner's Name,Address and Tel.No. �'QJ " 6 +30�5 b4e5 Av�c.. Assesso Map/Parcel 33 M' M` ( M A y(o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 JCS. Type of Building: Dwelling No.of Bedrooms e� Lot Sizea(�sq.ft. Garbage Grinder(�ok Other 'Type of Building ,N)or>P_ No. of Persons Showers(lif Cafeteria( Vj Other Fixtures LAOc,-ro V? k cae wp4 fir** , L A,*v fl2 y Design Flow 33 O gallons per day. Calculated daily flow gallons. Plan Date 3 a2- Z�'S Number of sheets Revision Date '- Title Size of Septic Tank trg-, Go,\ 'kcanit Type of S.A.S. Description of Soil Nc, �kG Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: -lid 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 o the Environme ode and not to place the system in operation until a Certifi- cate of Compliance has been issue b. i d of He i< Signed Date Application Approvedby Date AL, I iU Application Disapproved for the following reasons a Permit No. . Date Issued U THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired lam`')Upgraded( ) Abandon ,d( )by at � _Y3 Vj1Q� yr j L,--� m i )l 5 has been construct d i. accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.'100 5 dated y } ©S Installer E5�1-. Designer 5�4 The issuance of qs pepnit shall not be construed as a guarantee that t,a syste� function as designed. Date Inspecto R No. G co . R °' . Fee.., Q O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS liq;pozar *pgtem Cott!5tructiou Permit Permission is hereby granted to Construct( )Repair( )Upgrade ( )Abandon( System located at 3 U "n �,.)�� f 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 mast be completed within three years of the date Date:_.-_ '1 Approved b TOWN OF BARNSTABLE LOCATION 6� SEWAGE # VILLAGE - C 6"T ASSESSOR'S M9PG LOT ® 033 INSTALLER'S NAME&PHONE N0. ' i Zr SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 5 -0 C fro size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 leaching facility) Feet Furnished by 4 3 _ 7r 0 TOWN OF BARNSTABLE LOCATION -02 SEWAGE # VILLAGE "ram �fls ASSESSOR'S LOT INSTALLER'S NAME&PHONE NO Q 2VI v ) SEPTIC TANK CAPACITY 12 LEACHING FAcmrry: (type) d eow (size) NO.OF BEDROOMS, � a BUILDER OR OWNER ,s�� ✓E_____T[ �''�---- "� PERMITDATE: 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 leaching facility) Feet Furnished by ,9- , ,, , I' I +� a � 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems.Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, CgA7yEk._k _ VA"Y, hereby certify that the engineered plan signed by me dated ?a�t� ,concerning the property located at meets all of the. following criteria: • This failed system is connected to a residential dwelling only. There.are,no.commercial or business uses associated with the dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation testa at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information). ,p B) G.W.Elevation. +adjustment for high G.W._ DIFFERENCE BETWEEN A and Bj SIGNFrD DATE: f;7� 0 NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:\Septic\percexemp.doc , Ih Permit Number: Date: ' Completed by: HIGH GROUNDWATER 4EVEL COMPUTATION Site Location: 0­18 Lot No. Owner: Address: Contractor: �c�C ��� .� .1 ` . Address: «�� � , q-iA Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. ...................................... ................................. .Date 4) mon h/da /year STEP 2 Using Water-Level Range Zone and Index Well Map locate site:and determine: S OA Appropriate index well.................................................... OBWater-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ....................... J p , month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and'water•level zone (STEP 2B) determine water-level adjustment STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site (STEP 1) ........................... a� Figure 13,--Reproducible computation form, 15 f Town of Barnstable � E .� Regulatory Services Thomas F. Geiler, Director + BARNSTABLE, • 9� MA �0� Public Health Division �FD1AP'�A Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 4/12/05 Designer: Shay Environmental Services, Inc. Installer: Rodney Fisher Address: P.O. Box 627 East Falmouth Address: Main Street MA 02536 Harwich, MA On 4/11/05 Rodney Fisher was issued a permit to install a (date) (installer) septic system at 20 Westbury Lane, Marstons Mills, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 04/05/05 (designer) — I certify 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. 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 ce Zied as-built by designer to follow. ��X�\A OF Mq0,, o� CARMEN � E. Installer's ignature) SHAY W No. 1181 STER�O SgNI TA0' (Designer's Signature) (Affix Designer's Stamp 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:Health/Septic/Designer Certification Form *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. VENT PIPE (0 Least 24 inches toll)- SECTION A -A 10' min. from — Schedule 40 PVC w/Chorccal Odor Filter AU OUTLET PIPES FROM THE Existing Foundation 1—house to �eptic tank DISTRIBUTION BOX SMALL BE Ir PROFILE VIEW OF ADDITION TO LEACHINC SYSTEM Septic tank covers must be D-BOX cover must be SET LEVEL FOR AT LEAST 2 Fl. 12- CONCRETE COVER within 6 in. of finished grade thin 6 in. of finished grode 3" of 1/8' -- 112' Washed Peastone Grade o� Septic Tank N__ N�TA!Iffl AM' T! (1k WTHIN 6 OF GRAII\\ TLE AJNKr it Do" a) 1 ?5' 30' PLAN SECTION CROSS-SECTION Pri compacted stone > Not to Scale C JA- FIFfectIve Length NOT TO SCALE ' SOIL ABSORPTION SYSTEM (SAS) ° | | |c ' ' compacted stone EfFecthip Width 4) INFILTATROR HIGH CAPACITY (H-20 LOADING)/ GEORGE O'BRIEN GENERAL NOTES OTE: ALL COMPONENTS MUST HAVE RISERS TO—MT-HIN--6-"---B—E-L-O-W-G—RA-DE- 0 1. Contractor is responsible for Digsofe notification LN (OR EQUIVALENT) Not to Scale Bottom of Test Hole 1 Elev.=87.00 M No-Groundwatet Observed 0 132* NOTE OVERALL HEIGHT OF INF1LTRATOR IS 18- /EFFECTIVE HEIGHT IS 10- and protection of all underground utilities and pipes. -- ----------------- 2. The septic tank and distribution box shall be set 3. Backfill should be clean sand or gravel with no stones over 3" in size. Design Colculations 4. This system is subject to inspection during installation by Carmen F. Shay - Environmental Services, Inc. PERCOLATION TEST Number of Bedrooms: 3 Equivalent to 330 Cal./Doy (330 Col./Day Min. per Title V) 5. The contractor shall install this system in accordance Garbage Grinder: No with Title V of the Massachusetts state code, the approved plan Septic Tank : - 2 x 330 Cal./Day = 660 USE EXIST. 1,000 CAL. Septic Tank. 6. If, during installation the contractor encounters any Date of Percolation Test: JULY 16, 2004 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch soil conditions or site conditions that are different Test Performed By: CARMEN E. SHAY, R.S. - C.S.E. Bottom Area: 0.74 gal/sq. ft. x 370 sq. ft. 273.8 gallons from those shown on the soil log or in our design Results Witnessed By: WAIVER - (per Barnstable B.O.H.) Sidewall Area: 0.74 gal./sq. ft. x 78 sq. ft. 58 gallons installation must halt & immediate notification be Excavator: UNKNOWN Providing: 331.80 gallons made to Carmen E. Shay - Environmental Services, Inc. Percolation Rate: Less Than 2 min./inch Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. TO BE USED NTH 4.0' OF WASHED STONE ON THE SIDES, AND 35 OF WASHED STONE 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. ON THE ENDS. NO STONE UNDER. Test Hole 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. No. 1 10. All solid piping, tees & fittings shall be 4" diameter | Leaching Capacity Proposed: 330 Cal./Doy Minimum (Min. Per Title V) and Local Regulations- "",." »mL^ V. Schedule 40 NSF PVC pipes with water tight joints. 0 98.001cn Sandy Loom Properties Within 150 Feet. | 10 W 3/1 NOTEF | ~ -~ 145.00' COMPILED FROM THE PLAN BY MEYER ENVIRONMENTAL Sandy Loom ENTITLED "SITE & SEWAGE PLAN OF #20 WESTBURY WAY, M. MILLS, MA- " A 97.77 THE PROPERTY LINES ARE APPROXIMATE AND ! � 3 95.00i: AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ! Sand THE SEPTIC SYSTEM INSTALLATION C, 87.00: EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE. Failed NOTE ANY STRIPPED OUT SOIL CONTAINING LIA04ATE Leach I'll FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSL�) OF AS PER BOARD OF HEALTH SPECIFICATIONS. 4" PVC ASSESSORS MAP 26 PARCEL 033 VENT LEGEND ! / ' ! | / | i ! Groundwater Not Observed 0 XIST. 1004 gal. DENOTES PROPOSED / ' ~~^~~'^~ ''^` ^'~` No ~"p~^^e'^ Required^ DENOTES EXISTING SPOT GRADE X 104.46 SPOT GRADE PL PROPERTY LINE PROJECT BENCH MARK TOP OF FOUNDATION EXISTING ------F9 W­ PROPOSED CONTOUR i ! ( | || ELEV. 1OO.OD (Assumed) / | 3 BEDROOMEXISTING CONTOUR HOUSE ' / DEEP TEST HOLE & 2-18* w^w ACCESS M^w*oLEsPERCOLATION TEST LOCATION / / ` / . | . - / m / i / / )C wor 0 3 UTIE P LO PLAN r ' / ' � / / m _,' , / / �� -__ ' °e ^u�s co�n v* p* �vru nm", / --- --- ` -`f� �� - -- / � DISTRIBUTION mw AND LEACHING vovruw wr o, DE BELOW FINISHED - / / 01 PROPOSED SEPTIC SYSI GRAN��/'��x����0 mnow o^ � - ' - | sToa nowropocn pncu^cT oowonns n*rHM GRADEPREPARED FOR PLAN VIEW *mmu mr nTE GAS HAFFLFS OR Eov^mSING AUTHORITY . | � �+�r oo�n� /��� �� | � �°��= - -- ---- --- / � AT �nn / ` ' ` | � clearance ' ` L � c� / 33 &2< WESTBURY' WAY --_ _ -_--__--- - - -- - - _----' _ -' -- �a, | ( | »vnzr | MARSTONS MILLS , MA / «�� �r r �c�� �//' ��-- � �r 5 -� �c-� ^-� � �,_� �^ '� � .0 r� .�a '� PREPARED BY: /48 FOOT P|(.HT OF WAY) | 0 20 40 50 ic-) H ENVIRONMENTAL SERVICES, INC. ' CROSS SECTION END—SECTION ' EAST FALMOUTH, MA 02536 TYPICAL 1000 CALLON SEPTIC TANK IT ^ �ALE } ^^~2O' NOT TO SCALE J � ^—�' � 3CA/ | ' 20' DRAWN BY- CES DA| | | ----- --' PRDJL .J��D7D9 | FILENAME: 3D709PP DWG | SHEET I OF I | " | ' - _| /