HomeMy WebLinkAbout0021 MIDWAY DRIVE - Health -- 1'Y1 C C ILI
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Town of Barnstable P#
Department of Regulatory Services
a _ Public Health Division
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!+"� 200 Main Street.Hyannis MA 02601
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Date Schaluled ✓ j Time
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�-)j S , Foal 5asatabalaty Assessment for Sewage Dis Asa ,
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Witnessed B
onnroa � �A S: _ r I
RAL IlVFORMA N G
CATION&GENE ,-
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Owner's Name C� �� ^
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I,ocati0n � �_
q �„�.v �/s��,�� j Address
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Engineer's Na'm ����0�
Assessors Mapfflwel•
NEW COI jAiN REPAIR j Telephone#
slopes Surface Stones
land Use �3 ,•� � /s A L (96)
r I �( ft Drinking Water Well� ft
Distances from: Upon Water Body t ft Possible Wet Area,��---
Drainage Way 0 ft. pr'oPerly line ft Other R
SKETCH:(Strmt name,dimensions of lot,enact locations of te�St holes&pen%tests,locate wetlands in proxihtity to holes)
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Moo
� ITS t Depth to Bedrock / N rn
parent material(gedlogTc)
Depth to Orwmdwaier. Standing Water in Hole:
Weeping ftom Pit Fact .
Estimated Seasonal high Groundwater
AL HIGH WATER TABLE
D�T'ERNIIN TION FOR SEASON
in.
Method Used: obs hole in.. Depth to tgll 111otti�: ft
Depth dbperved standing in, Oroundvwa�r Adjuabrlettt
Depth toiweepiug fmm side of obs.hole: - Adj.{aetor. Adj.Groundwater L9vel..s
Index Well# Reading Dace Index Well level
PERCOLATION xESx �
Observation'
Hole# (J}
<< G6�5 Tine at V ^'
Depth of Perc "-z�— 2 o -
Start pre-soak Time.@ r—�--
End Pre•saak
Rate WmAnch
Site Failed; Additional Testing Needed(Y/N)
Site Suitability AsseMment Site Passed --
Original: Public Hek1thDivision
Observalion Hole Data To Be Completed on Back
*** pn testis to be conducted within 1 wetland,you must first notify the
If percola• 00'of •
Rsrrnstable C�l�servation Division at least one(1)wetik plrior to beginning
DEEP OBSERVATIONHOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Older
Surface(n.) (USDA) (Mansell) Mottling (Sw Stones.Boulders.
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`� Omen
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DEEP OBSERVAITON HOLE LOG Hole#
Depth from Soil How Soil Texture Soil Color Soil Other
Surface fn.) (USDA) (Mansell) Mottling (Struchue Stones,Boulders.
5�
v= ^
4 !
O L nJ� 4YK -714
DEEP OBSERVATION HOLE LOG Hole#
Depth from- Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (ShvaWM Stones.Boulders.
;DEEP OBSERVATION HOLE LOG Hole#
Depth frown Soil Horizon Soil Texture Soil Color son Other
Surface(in.) (USDA) (Munsell) Mottling (Stmetul%Stones.Boulders.
Flood Inmmke Rate Mau: /
Above 500 flood year boun No— Yes .✓
y �
Within gW year boundary No Yes
Within too year flood boundary No Yes
Depfb of Nafidaliv Owarrine Pervious Materla
Does at least fo feet of naturally occurring.pervio mtiterial exist in all areas observed throughout the
area proposed• r the soil absorption system?
If not,what-is the depth of naturally occurring 'bus material?
Certification
I certify that on.�✓y �� (date)I have passed the soil evaluator examination approved by the
Department ofn nmental Protection t the abov®analysis was performed by tide consistent with,
the tequii�d train' ex ri described in 310 CUR 15.017.
Date.�7-A;,2W6
• signature
_
QM.BP 1IMERCl ORM.DOC
P� pw RG'N"S ABLE 01'
� Vr
TON O��BARNSTABLE
LU,CATION �ne� _ - SEWAGE 4 aC a
VILLAGE C O,rN) ASSESSOR'S MAP&PARCEL aZ —
INSTALLERS NAME&PHO E NO. � ,1�,
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) L (size) X .2Z-Q
NO. OF BEDROOMS X %XA txke
OWNER
PERMIT DATE: bCi /O COMPLIANCE DATE: le
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ��w` 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
Y FURNISHED BY S-1 e- k(-V\
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x
2cr
No. ®� ► Fee 'S
THE COMMONWEALTH OF MASSA .HUSETTS Entered in computer:
.PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
ZIPPYicatiou for MtgPo!5a16p!5tem Couq;tructiou Permit
Application for a Permit to Cogstruct( Repair( ) Upgrade ) Abando ( ) Complete System ❑Individual Components
1 t� — L� 7 v
Location Address or Lot No. (a- aC Owner's Name,Addre s,and Tel.No.
Assessor's Map/Parcel 11�(,.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
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) 3 gpd Design flow provided _7Lf C/- gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /,P U &AL Type of S.A.S. t9 b _ J
Description of Soil yss.,1
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 Board of Health.
Signed Date
:.Application Approve Date
Application Disapproved by: Date
--for the following reasons
Permit No. r-- Date Issued
,No. 'V c' C� a a e: Fee J
r k w ,'H ETTS Entered in com uteri r
COMMONWEALTH OF MASSAC p -�
,! PUBLIC HEALTH DIVISION=TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rppricotion for �Bigpo!goY 6p5tei m Construction Permit
A '
Application for a Permit to Co struct Repair(( ) Upgrad ( ) Abandon( ) •�Complete System ❑Individual Components
Mi wN�a. C, or �s �� n rf , ila p.
Location Address or Lot No. 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.
s V 5
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) 3 gpd Design flow provided -7Lf gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank �.f ClaL, Type of S.A.S. a 14.2 _no Goy( C kr",b
Description of SoilC
Nature of Repairs or Alterations(Answer when applicable) Ze
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.
Signedqq Date ` / G
Application Approved`by _�t� Date
Application Disapproved by: Date
for the following reasons
LL01 L .
Permit No. Q Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERRTTIFY,that the n-site Sewage Disposal System Constructed (i/ ) Repaired ( ) Upgraded ( )
Abandoned( )by
�.� at �� ��: (�^C VS ( � _ C-V ��� has been constructed in in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. ey"z�__I dated
Installery �t•tN�u Designer
#bedrooms Approved design flow C�,3
gpd
I\ The issuance of this permit shall J�n Te construed as a guarantee that the system as`dNesigned.
Date b Inspector '
------fir+--` --- - — -- -----=-- ----__/�
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Digonl :� !tern Construction Permit
Permission is hereby granted to Construct Repair ( ) Upgrade ( ) Abandon ( )
System located at q')(P LC,-,C, C•y i NW,
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 musp /be completed within three years of the da e of this permit.
Date IP�c�`7�(Q Approved by
r
Town of Barnstable
ces
R.eguiaW �e .
Thomas F. Geller,Director
MASS. Public Health Division.
Thomas McKean,Director
200 Main Street,Hyannis,NIA 02601
Fax: 508-790-6304
Office: 508-862-4644
Installer&Designer Form
Date: _�/�2006
Deslgz�er: LL Installer:
Address: £ Address:
On was issued a permit to install a
(da#e) (installer)
s tic system act ! T�iJ n� E based-on a design drawn by
�
dated ? iL OIL
{ igner)
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.
r 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 Aegulations. Plan revision or
certified as-built by designer to follow.
��pySH Of ssgo z
3TETQON 6G��
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�er's Si ) HALL z N
No.527 Q
s ED SP���PQ,
EVA03
esi Sigc�ature) (Affix Design s Siamp Here) _
PLEASE I�ET` tN T® �A)t2NS'I''ABLE PUBLIC HEALTH DIVISION. CERT'IFiCATE
OF COIVIPLIANCE WILL, NOT BE ISSUED UNTIL BOA` THIS F®� AlND AS-
OFJILT CAS AI2E RECEIVED BY THE .DARNSTABLE P LIC HEALTH I?IYIS$ON.
THAN YOZJ.
Q:He&&/SC0C CSiX 'Cafficalina Form
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TOP OF FOUNDATION
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OR SCHEDULE 40 4" SCHEDULE 40 P.V.C. (ONLY) 9.' MIN . • LEACHING TRENCH ( /-) REQ.
� P-V.C. PIPE MIN. PIPE- MIN, 36 MAX.
i/8"- 1/2" WASHED STONE
i' PITCH I/4"PER.FT - 4 tfc 2" << 4
4 PER.FT. �
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/ MgRC q (� �•• z EL.�¢$s• EL��: �. 'o'�c�;o-cj;'c_�•' c�- . ,
VE P R INVERT 1,50 p INVERT-J .► . � - �• 0 p Et.G/.9S
GAL.. EL G4 8 C11 ST. INVERT _ 3 4 -I
W - j L• ¢ BOX Precast 500 Gal. Leach / " I/2"--�
E a LOT ., , 6 CRUSHED STONE EL�¢'Db••• REQ. OvL-r-
/ F►. / ' ( ) Chamber WASHED STONE
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P / _� _co LOT G. 17 ,� L , .••- . � GROUND WATER TAaLE
o n, f8 , SOT � ����r' rr Fiz z. SEWAGE DISPOSAL SYSTEM TYPICAL CROSSSECTION
o �, J 9 / SOIL LOG No SCALE LEACH I NG TRENCH
/ O ' obi DATE . .'�. �. . . . . . . . TIME . . . . . . . N0 S!_ _
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/ r'k� _ -_ � ` �i � � TEST �o� ^c� T�sl .4 4.- � DESIGN DATA .
ELEV. (-. •_�. . . . _ . . . LEV. . . . 9. . . . . . 1 1/8 _'1/2
N LOT J ' 3 9. ./1N. W,S;-i_ED 36 MAX.
f7 LOT LOT Z N r //�r ' .:..oy 4.�,y � ., rIU R C= ...r► S . . . . . . . . . . . . . . - r N
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/ / J V'~ I 15 ! / �.0 7 "� 1 ` //,i/ rd a1.po �r� ��¢ E .,cn,L tea.L TOTAL ESTIMA E.) FLOW . •.3.? . . . . . GALLONS/ DAY _ _ _ 8„
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J Mct) - - _ i }a : cz. c/ z 1- ..t BOT r M =4 ;I N n AIR . .`3. o: . . -
I- cO r �.73 Gonsn '0 L C �A z S SQ rT./inENCa fi C7.'L� �C]- 24"
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,,� I Cj s�►r,n ��' /c-uc. �oyiZ ��C SIDE LEACHING AREA . . . fJ/, ` Z. . . .3Q.F T./ TRENCii [� L7; dr,
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O � O L O J � 4„ ' P��,t�' c.z. 43 CL• G.�,�o Q /VU/�E- o c - -
c� _ T 3 f �; �, / r Lr y GARBAGE DISPOSAL - . . .( 50 /o AREA INCREASE )
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TOTAL LLACHaNG AREA .z'.�. . . SQ.;T• z'S
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I m ' 3 ° �/ r L `�"` % CZ s,,�� "'yK/ °ERCOLATION PATE .�:�s Tl�. xr . .�YQ !`7!V PER. INCH 1
LEACHING AREA ER PERC0LAT 10N RATE .� / !:S. SC_ F a
C 3 Shun ,oyiL�¢ Nc GROUND 11:.T ER i,.2L.
5G,91;^ APPROVED . . . . . . . . . . . . EOARD OF HEALTH
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c� -- _ �8 - ,,• " T,NY'` / �' `` �'YIT��1 ESSED BY AG�.r. l OR INSPECTOR L/
J_ q0 hu J r \ Don/ ,7) S/�I9/zA/S BOARD OF HEALTH y7G /�Nin�.v� 5 G�wL c
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SITE PLAN IN BARN STABLE ( CENTERVI LLE )
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_ DETA I L PLAN " R/CH,4RD P MORSE , JR-
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-- �, -- i SCALE I '�= 20 ' �� \
� N APR I L 247 2006 SCALE AS NOTED
REVISED JUNE 147 2006
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EDWARD E . KELLEY
- - o REG . PROF. LAND SURVEYOR
o o - K BOX 5
TS Y
CUMMAQUID , MA. 02637
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SCALE IN FEET 1 100 FT. 3
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