HomeMy WebLinkAbout0133 EVANS STREET - Health 133 Evans Street, Osterville `
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TOWN OF BARNSTABLE
LOCATION 3 3 SEWAGE #
VILLAGE 0 -5 ASSESSOR'S MAP& LOT f
INSTALLER'S NAME&PHONE NO. rs
SEPTIC TANK CAPACITY /S'6-:
_ LEACHING FACILITY: (type) hQ-Q (size)
NO.OF BEDROOMS
BUILDER OR OWNER_A/L (�7 d 1L kn/C X
PERMI TDATE: /G COMPLIANCE DATE:AO
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 fX612
'hing facility) Feet
Furnished by
c3 1J ` • ,.
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k
No. Co �- L(35
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for �Xgpogaf �&pgtem Cou0tructiou permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System Individual Components
Location Address or Lot No.�- ����� Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel ig/ox 00.—
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 3�0 gpd
Plan Date —� Number of sheets Revision Date
Title
Size of Septic Tank �"�/1'T� Q 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 Board of Health.
Signed . Ocoo� Date
Application Approved by �^ Date (/
Application Disapproved by: Date
for the following reasons
Permit No. Ra/6 ' 3 S Date Issued 10 -w
———————————————————————————— —
,
jo — Li 35
R
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
e Yes
` PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ZIppgicartioH for �Bigogal 44p�tem 'con.5tructioH permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon,( ) ❑ Complete System Individual Components
Location Address or Lot No.4fT����'� Owner Add ress,
O p
Assessor's Map/Parcel ���aZ /q
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
4e,4 i�'p B, ,r��.J'r�'`�/ �J',
• I
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building .J^ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
l
Design Flow(min.required) 3 3 a gpd Design flow provided gpd
'Plan Date / �°� v�a Number of sheets / Revision Date
Title
Size of Septic Tank �X'J' ' Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
X
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.
Sig ne Date
Application Approved by Date
Application Disapproved by: Date
for the following reasons
Permit No. as 0 3 5 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by S.-,ow e
at has been constructed in accordance
35
with the provisions of Title 5 and the for Disposal System Construction Permit No. aG/b _ Cl dated
Installer Designer .O-t f " 0 45-
#bedrooms 3 Approved desi n flow .0-40 gpd
The issuance of lis pdrmit shall not be construed as a guarantee that the system witIIf�ti n as designnLdam. (�Date ,/0IN Inspector P � �-¢-'� b,
t -
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS
�Digozal *pgtem Co 5truction Permit
Permission is hereby `ranted to Construc Repair Upgrade Abandon
Yg t � ) p � ) pg � ) � )
System located at
d
and as described,in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty 4
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this�eya�.it.�
1 �
Date ( 6 ��^ 1 Approved by
Town of Barnstabl
r Regulator- Services
Thomas F.Goer,D eetor
PubfCc health Division
'MQA "McKean,Diver-tor
200 MWn Street,$yan Ws,MA,.02601
Office:.508-862-4644 -'Fax: 508-790-6304
]installer&Designer Cerrdfication Form
Tate:
Designer: 1 ! Instakler:•
Address: . Address: L4 4,.jwL ^`
pn /o--�04-00"� � C.�,�,1 t issued a permit to install a
(date) 2 (iiasta2m)
septic system at / 'U�J �{ t . �l based on a design drawn,by
(address)
dated
(desigoer) �—
j eatfy that-the septic system refm raced above was installed substmxiia ►according'to
.' ke design, which may iaclude r air agprov'ed-changes such as latent•i�locatioij 6f the
ilY�ution box audlor_septic tak.. ,
l cerWftt the septic system"faorenced above was uastaIL-d w;it3i's�a�r.changes (�:e•
g�eate $se'19' lateral zelocsbxs of the SAS oz�any.vezca =aoga of any compon.�gl
of the.septx"cys m}but i�i aoca�dance vcrith State t T,0C4Regtilaii=,, Ban revisiork or,
carFied as�-bydesune�ta'i
- taper's Signatr�r ) .. ~.• •Y
e tMON
(D er s Signature) ?statktp A,eze)
S(('yy jW�'''1/'�E .11�.L•f IIMN 9l' JY- �YYST•gip i!�- MC HEALTH
I/t� *ir�yeMyo�- R C -
VA
hff
0:I4etl cptic/Dr,6iPerCffWirA4Form
TOWN OF BARNSTABLE
LOCATION ���' �"�A>"f' �S'T SEWAGE
VILLAGE �J'T�,���'Il� ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY �iN>P7/Ao,6: oo o c 9yZ"ev, ,
LEACHING FACILITY:(type) (size) / Xa sh'a "
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: COMPLIANCE DATE: /I —
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
FURNISHEDBY
�ZrA.,, sir
GARAO'
Town of Barnstable P# 31
Department of Regulatory Services
BARNWABLB.: Public Health Division Date
erase
200 Main Street,Hyannis MA 02601 '
A
Date Scheduled /0 Ze Z O I v Time Fee Pd.
Soil Suitability Assessnyntfior Sewage Disposal
Performed By��. Witnessed By:C .
4
LOCATION&GENERAL INFORMATION
Location 3 Address
� , _. ---._ __- Owner's Nam-
f_� — Address ��',/�"ylll
Assessor's Map/Parcel: 711 Engineer's Name, MO
NEW CONSTRUCTION REPAIR Telephone#
Land Use , Slopes(%) Surface Stones _
Distances fr : 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 lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
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Parent material(geologic) r 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# 3 I _ Time at 9"
Depth of Pere OT� Time at 6"
Start Pre-soak Time @ Z Time(9"-6")
End Pre-soak //
Rate MinAnch /G Zwv _viq ,
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
y Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC w
;may _ •�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil er
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Oil
u
,VC> 2e40.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Graven
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.%Gravel)
Flood Insurance Rate Map: /
Above 500 year flood boundary No- /Yes Y
Within 500 year boundary No Y/Yes_
Within 100 year flood boundary No✓ Yes_
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring perv'o to 'al exist in all areas observed throughout the
area proposed for the soil absorption system?
' If not,what is thWof ly occurring pe ous material?Certification
I certify that on date)I have passed the soil evaluator examination approved by the
Department of Etection and that the above analysis was performed by me consistent with
the required training,experU5e and ex e n e scribed in 310 CMR 15.017.
T Signa a..w Date
Q:\SEPTIC\PERCFORM.DOC - -
Wr /P
No. "�� Fee $5 0 .0 0
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for IDi5pool *pgtem Construction Permit
Application for a Permit to Construct( )Repair( x)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. 1 3 3 Evans St Owner's Name,Address and Tel.No. 4 2 8—5 8 2 0
Assessor'sMap/Parcel Osterville, MA Maurice McCormick
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.
Wm E Robinson Sr Septic Sry
PO Box 1089 Centerville MA 02632
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( np
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil sand
f
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic_ system
consisting of 1500g tank, d-box, and three #330 leaching chambers.
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 Envi onmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B o e th. /
Signed Date '- Fe
Application Approved by Date
Application Disapproved for the following reasons
Permit No. Date Issued
—— --- ———————————————————————— ———————
50 00
No. lJ R� �� _ Fee _
THE COMMONWEALTH OF MASSACHUSETTS --"`Entered in computer:
r'. Yes
PUBLIC,,HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
` "Applitatiori for Permit
..s
Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
t Location Address or Lot No. Owner's Name,Address and Tel,No. 4 2 8—5 8 2 /i"
133 Evans St
Assessor's Map/Parcel Osterville, MA Maurice McCormick.
k
Installer's Name-;`Address,and Tel.No. .7 7 5_$7 7 6 Designer's Name,Address and Tel.No.
Wm El"Robinson Sr Septic Sry
P01Box 1089 Centerville MA 0263
Type of Building: ;
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ��
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title '
Size of Septic Tank Type of S.A.S.
Description of Soil sand
x
Nature of Repairs or Alterations(Answer when applicable) Title 5 Septic system
°,. consisting of 1500g tank, d-box, and three #330 leaching chambers.
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 Envi nmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this B of eAlth.
Signed oA Date 16
Application Approved by 0 Date
Application Disapproved for the following reasons
Permit No. f , Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
McCormick ` ,; i•��;
Certificate of Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( x)Upgraded j j )
Abandoned( )by _
at 133 Evans St, Osterville h � constructed in accordance
with the provisions of Title 5 and the for Disposal'SystenrConstruction Permit No. ��G!dated
Installer Wm E Robinson Sr Sept Sry Designer ; ,
The issuance of this permit sh of be construed as a guarantee that the sy t w I. un rytion as d '.lied 1
Date !t� Inspector � �C -_ >f
-- — ----- — --- —'�---- —
lNo. D �-- -- — --- -- -- � Fee$50.00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS F
.McCormi-c,,k lwigpozaf *p!tem Construction Permit
Permission is hereby granted to Construct( )Repair( N)Upgrade( )Abandon( ) y
'"'Sys a located at 133 Evans Street
Osterville
Installer: Wm E Robinson Sr Septic Sry 1
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 Viust be completed within three years of the date of t
q q ; ,}
• Date: � Approved by
NOTICE: This form is to be used for the repair of failed
septic systems only
h
CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL
WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS
I,William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated &/�,/- q - ,concerning the
property located at 133 Evans Street, Osterville, MA meets all
of the following criteria:
4 T re are no wetlands within 300 feet of the proposed septic system.
T re are no private wells within 150 feet of the proposed septic system.
A Toe obseved groundwater table is 14 feet or greater below the bottom of the leaching facility.
��Te is no increase in flow and/or change in use proposed.
There are no variances requested or needed.
SIGNED: i ' DATE �� —/j 6i —9
LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
(Attach a sketch plan of the proposed system_ Also if the licensed installer proposes a certification
plot plan,this plan should be submitted).
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i OWN OF BARNSTABLE
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✓ .ems 91 SEWAGE #
LOCATION 3 3 . G A . .
1 VILLAGE 0 S ) ASSESSOR'S MAP.& LOT
6 use �- . 27s-� 1,
INSTALLER'S NAME&PHONE N0. 6 i �-9
SEPTIC:TANK'CAPACITY
LEACHING FACILITY: (type)����6 �A�t (size)
i NO.OF BEDROOMS
BUILDER OR OWNER S a /C An C
PERMTTDATE: 16 l —9 7 COMPLIANCE DATE•/d
Separation Distance Between the-
Feet Botto
m of Lea
ching Facility
Feet'
Table an .w er T 8
d'usted Gr
oundwater
u nd at
Ma
ximum
um Adjusted
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 fee lea 'ng facility) Feet
Furnished by 6 / ,'-J C /1'
j3, CZ
i
ASSESSORS MAP : I Z- TEST HOLE LOGS NOTES:
PARCEL :.
SOIL EVALUATOR : -
VALUATOR : G 1 The installation shall comply with Tit
� FLOOD ZONE: �,/a% �q �,aC.1��4,L.•�. ) p y le V and Town of Barnstable Board of
-- - -- -- - WITNESS : i
Health Regulations.
REFERENCE: C'�" /�/�"� ,�L07- ,X�+� � DATE: 2,� �1
2) The installer shall verify the location of utilities, sewer inverts and septic
_- PERCOLATION RATE: 1 ,
qX7 � )1 � 121. 1Y g D 2 components prior to installation and setting base elevations.
/ MM
-- 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first
TH- I TH-2 two feet out of the d-box to the leaching shall be level:
Jr, d vArs? 6 � ,C��►� dWyt' 4) This plan is not to be utilized for property line determination nor any other
�o � L i py L purpose other than the proposed system installation.
-7` 7' - 0 5) All septic components must meet Title V specifications.
p a/b / 6) Parking shall not be constructed over H 10 septic components.
2�
31 1, 1 I AP'
7) The property is bounded by property corners and property lines.
L O C A T I ON MA P L JC ), 8) The property owner shall review design considerations to approve of total
design flow and number of bedrooms to be considered for d t
design. Receipt
L g P
CI1102 ' ✓ '✓ �� v' of payment for the plan and installation based on the plan shall be deemed
7, t+ 1 Z approval of the design flow by the owner.
t 9 The existing leaching or cesspools shall be pumped and filled with material
u0�� per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced with clean sand per
Title V specs.
i ,��,VII__ ��( 10)System components to be 10 feet from water line. Sewer lines crossing the
water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if
SEPTIC SYSTEM DESIGN applicable. The proposed SAS is being installed below the water service
line. The line is to be sleeved as aforementioned and maintained in place.
_� 11) If a garbage grinder exists it is to be removed and is the responsibility of the
i I FLOW ESTIMATE owner to ensure such.
12)The installer is to take caution in excavation around the gas line if such
BEDROOMS AT //O GAL/DAY/BEDROOM - 35DGAL/DAY exists.
13)The installer shall verify the location, quantity and elevation of the sewer
�'- - -
SEPTIC TANK
-- ^--- - lines exiting the dwelling prior to the installation.
GAL/DAY x 2 DAYS GAL
USE X DCGALLON SEPTIC TANK
SOIL ABSORPTION SYSTEM
DrL WENS w
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�IN, { i1b \ S DE AREA: Z X z� f v X ZXZ7 :- /��,��•BOTTOM AREA: Z X /� � O rZ No.1066 0
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1�-- SEPTIC SYSTEM SECTION
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GAL �,1� 7Lti-
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10 SEPTIC TANK I
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X �3 ,
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or-7 40Lf
Z� V s / SITE AND SEWAGE PLAN
LOCAT I ON : 13.E VIAII,-1Z2
PREPARED FOR
CALE .ZO
DAV I D B . MASON R5 DATE: (U 2D 220
DBC ENVIRONMEN AL DESIGNS
EAST SANDWICH . MA
W DATE HEALTH AGENT ( 508 ) 833- 2 177
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