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HomeMy WebLinkAbout0026 SECOND AVENUE (HYANNIS) - Health 26 Second Avenue A= 267-019 Hyannis I " TOWN OF BARNSTABLE LOCATION a �, �Ct bred ��� SEWAGE# VILLAGE U-- I wrrq-sP0(VSSESSOR'S MAP&.PARCEL INSTALLER'S NAME&PHONE NO. SG6���'✓ S`Z�i{ d��f D(�fo t SEPTIC TANK CAPACITY 10 t LEACHING FACILITY: (type) C C g (size) NO.OF BEDROOMS OWNER PERMIT DATE: )S 1 ( COMPLIANCE DATE: ; Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) AJA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) __ AJIJ Feet . FURNISHED BY A t - 2!K. co M w��t.r c.�•..4 N.1 = 21 AS= 3y A LJ AS No. ! 1 L-Gq Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEAL—DIV'tSION-TOWN OF BARNS'�ABLE, MASSACHUSETTS e•. EY r��� • r 01pplitation for Disposal 6pstrm Construttion 3PPrmit Application for a Permit to Construct( ) Repair(%/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ' ( 3e COn d kx, Owner's Name,Address,and Tel.NJo. Assegs'o�I�apP t cel G.a. kMYwo'l:i a Z>Q Sc r, � �`V Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �jW sq.ft. Garbage Grinder(f Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 6 gpd Design flow provided 7a G gpd Plan Date- f�3 O 3� Number of sheets Revision Date Title _ Size of Septic Tank � �t�( f a(3 0 Type of S.A.S. � ( I�,S Description of Soil l:QCai S �ZC .�' J n .S G✓. �U0'S e Nature of Repairs or Alterations(Answer when applicable) ® l3J CCA 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 (X Date /ealth. ,j f I Sig / I S Application Approved.by Date Application Disapproved by Date for the following reasons Permit No. Q Date Issued No. d 1 `7 G� ., Fee THE COMMONWEALTH OF MASSAC ISETTS Entered in computer: Yes _ .` . PUBLIC HE ►L'TH DIM.1ON''1 TOWN OF BARN SUB LE, MASSACHUSETTS ftplitation for Mis, osar stem Construction permit Application for a Permit to Construct( ) Repair(14/Upgrade;( ) Abandon( ) ❑Complete System ❑Individual Components Location Address Address's�or Lot No. L 3e cc)n w .Owner's Name,Address,and Tel.N Assef K4a0aer`el l.�. k1yGM�J 0 r Sv SG`I G•` , Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. \NC,C, Fr L� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(No Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 r gpd Design flow provided 3G G gpd Plan Date Number of sheets Revision Date Title _ Size of Septic Tank �X f a 6 O Type of S.A.S. �'{ ( GG r0 x d U Cn P, )Ar_fveS Description of Soil f2 6 W S U .�' 1 n .3 C,^c d Sf0/ Nature of Repairs or Alternnations(Answer when applicable) 2Q U S CA -7 O SSczS 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 ealth. / �) S Sign d Date57 Application Approved by _ Date Application Disapproved'by Date for the following reasons y I Permit No. U` )\ G Date Issued THE COMMONWEALTH OF MASSACHUSETTS r BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by kc, I' at =7 C„ ��' �o n CJ A vc (�J• NyGM�5 fllsrblen constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No.p O �—LIG I dated `� Installer - r, (� Y^^^�`�'`� Designer �AcG�5 (G 5 V � #bedrooms •�(� Approved design flow of(7,U gpd The issuance of t/his, er fmijt sha11 of be construed as a guarantee that the system wiTl'function as designed. Date / / L r Inspector i -------------------------------------------------------------------------------------------- No. ( — z" 1 Fee Jo G THE COMMONWEALTH OF MASSACHUSETTS r PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) _ff ep Repair( � r Upgrade( ) Abandon( ) System located at�6 SQ COS V i `k•,e 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 e com leted within three years of the date of this permit. Date L� , Approved by / i i r Town of Barnstable Department of Regttlatory Services' i Public Health Division Date 1 I /I A lEn.19.A�d� 200 Main Street;Hyannis MA 02601 Date Scheduled ' h ' N- Q Y I//nn 'Ti.me Pd.Fee V Soil Suitability Assessment for Se e Disposal Perfored.By: S I L�-t-e— � �j 17 E. y �� Witnessed B : m LOCATION& GENERAL INFORMATION Location Address Owner's Name Address Assessor's Map/Parcel: PU `a.C, 9 Engineer's Name NEW CONSTRUCTION REPAIR, Telephone#. Land Use � �af'r'���'� slopes(` ) G Z' Surface Stones y Distances from: Open Water Body tt Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Une 1C�"�' ft ' Other. ft SKETCH:(Streefname,dimensions of lot,exact locations of test holes&perc tests;^locate wetlands in proximity to holes) 4. trc- a Parent material(geologic) Oy—r-'�,I Depth to Bedrock Depth to Groundwater. Standing Water in Hole: Weeping from Plt Rice- A.) Estimated Seasonal High GroundwaterY DETE] NATION FOR SEASONAL HIGH WATER TABLE Method Used: - /`) Depth Observed standing in obs.hole: In. Depth to soil mottles: ln, Depth to weeping from side of obs.hole: In, Groundwater Adjustment f. Index Well# Reading Date: Index Well level Adj,factor Adj.Groundwater Level , PERCOLATION TEST bate 1Y 3 tl Thne Observation Hole# Time at 4" Depth of Pero S.Z Time at 6" Start Pre-soak Time.@ Time(9",61) End Pre-soak Rate Min./Inch GZ Site Suitability Assessment: Site Passed ✓ Sitc Failed: Additional Testing Needed(YIN) 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 DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i ten.:'y.%'Gravel) 3Z L 5 DEEP OBSERVATION HOLE LOG Hole#_Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. e -Consistency.%G ve 00- A Z� LSD VEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisterev.ela Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Othe- Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency. i Flood Insurance Rate Man: 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 pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious matorial? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra' ' ,e plertise and experience described in�10 CNM 15.017. •. Signature Date Q:1S.EPTICIPERCF0RM.D0C �12 Town of Barnstable AM Regulatory Services Thomas F.-Geiler,Director Public Health Division s6S9. Thomas McKean,Director 200.Main Street,Hyannis,.AM42601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: • A 13 111 Sewage Permit# JQ 11 ~ 0 t Assessor's MaoTarc 9 Designer: !�,i�P K&-3 k VVAA!:�,QC Installer: ly:lc [— E/1C.L� Address: 9Z3 A Address: ii3 ©t b teh2,-676, 1 4 yU.7� H YA-j»+S. M A. 1 4n was issued a pemut to install a (date) (installer) septic system at e c C )(\8 IAAsign­<drawn by (address) K PR A• i-1 �, #`�E dated 7o 1 (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 certifythat the se tic system referenced p y r need above was installed with mayor 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 Regulati sion or certified as-built by designer to follow. Ar ' �✓ '"(t� S 1 3 (Installer's Signature) A 344 � z r r b (Designer's gnature r esi er s Si ) (Affix Designer's Stamp Here) ' PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION GRi�ATE s OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH.TIHS.`II� 3- BUILT CARD-.ARE RECEIVED BY THE BARNST.A;BLE PUBLI��I��' :IISION. THANK YOU. , � ._ M i MO, X 'Ib -Prix 15 171� Wr A, -�,4 WRO wmv T", M5 NZe-,"' WlEXT"W%�,;i,- v �4,A a 'A Van-'R -K`!�-�--;' vq� �&E I R2��, � &va,,� P"M TM =30 I W" 0§SIR INIMNE MEMO No 100 77 7 7 W A4 2 OF wit; .0 44 R 4NSP Cff N V RT /)Wuu 14 IAN E bN 't, ANK' C 7 T, I S U N VtR r N D ;­PERE ski a 777 LAI 'OF E�DISPOSAQSYST "ONL R T.IOU BEDRO EOUALS 0=14; Nv A maimm IV-sot." lot: K� INVER tC--�TANK,.lREQ IRE 101 100 PMMY 4NFITRATOR , bASE'RVED­6R0UNDEW T ,' CHAW fl, CALTDAT W-`13"A$,SUkED ""F R A6 w6m A H 0 UND�A ND':2 �BO'TTOM OF 4�.pEACH "No ENvq "PLAN irl 9 ����'CHAWER VIA vw�- ain on?:. 6fi6QqVU%WA I EX 'BV - NT Ism 70mom AMBERS TIN TRENCH 1`00=0 I N 0 NOVI 000,�-GAL,�"fX fSIT-1 N6" off OM dd Y 0-4r T4E AND LV now,A.= -two, A,,�Y IF ,RE0.V OAR JFHE Q-THT E nz "1 MY most, 6 �CRI yell 4 AC I N/1 ff- W: 4 Q 41" own, "vx"04104- nQM; onx, 1 A6 "Zia: 0 TFAV, OUPONE WDER S 'ALL' �GREATi R-VT A A L UARE K -AS�--`SUB C I 'iC r 4 ,,OP 15 Z4 N�,DEi TH EC Wf T" PD,1 KAPQ-014 Out WE A t)", 0 AM low, %y­ QQT� T�— - ,-b L� ANON 7 woo nCHAMSE� LETSEVER-PIP -5- HALL' BE,,SCHEDULE 40 PVC Wks zn, -Wo goo-,Who&=KiE, AW ANY,TLoan P 0 E tic:10v E tlC:TAtVKl-,AAO i'D-BOX�,SH4 L,7 E 1 5"win am nwv !I T 7T,-ED", Tvllzi ONE to IV A T 01 SSE v -0 THERE-J I A ES' Too �:,TEST Was, 51 5.014"LOU WD WA =One 41 t GROb nofly `Olt 7E:AND P`F"""Ak tidy vm��LOCATIONO 0 HUM Eno OAMY &k a A W"-, F4UAhDER(3R`00ND'7 U 6- too, T� .1w 1, now- ME AW TWO; 5 �HAL L N' T I --TV,�--tONS TR T-1 I-GNjt)NMfN ER T 0 DA YS:,PR i OR CHEDW into, �,Twy 14D �AI�LOW"FOR S IVY in A VAM -a AND''"' W111 INSPECTIONS �7 W Q 7 � n -vans- IN, 0 YR,; '52�, 77 1�1 " =N its, can zA; U'VUA­ DRELLINU N YON v bosoms ski �#tto�, CONSTRUCTION' ' Oily! 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