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HomeMy WebLinkAbout2811 FALMOUTH ROAD/RTE 28 - Health 2811 falumouth R��, 0 W4 e 7 Tv Ommme N, i 1,g Re, .k A 121 01� ,AS V!yk US Hu V. V', A& M" rN, V'­N N ON Q 9 M-01 pvv MW R"v AIM ­q4 T gp� Mii% "i Vn I V,� , T'4, J,4 I NIN W 10 ift" ,4j��,z�w �61 Vz M,MI. ".W i g�A U4 ulk q0p out 2 J��. Q0 WN N.V. R, 4M ljjS V O&V AA 27N S_ ly-SAY -0 -SON was X I W ii,nN V 14"i ­_ ly #f­1 17 1V `k�WAVW7�1;ZwfRrf', I izm-q 1 up saw Uk $1V tv, I'VI MAP 0� A 14i 31 MW EC. ffbTf"A W I W4"Ll'i It I milli R n-V 141 I ®r 9 W �Ay '�g ago gg V k met AW" 9M low", Y! NEW �T!.21411 WN Rtw I go, l", RATZ1,I.RuTROWS, t,jn.',,J 0_4."Mht,'� -3 'Wh"h0qVi" %q "MIA, pj 1l,1511 NON T. 4.i ow q,g n f AV'W'l"'VIA 20, %;MV Yr TIM, Y4W. 4, aw G IWO 4 WNW- R -�M , A. 'A 'p "WNY fWky �in cc "Mow 0 NO— '01 X_1 vi, A Wp -", �* g 7i .A -R, _01k `;Nfl 1W v Rs 4A Elm 4 M'Q MAN OF ownWIbi T:i qp,,vv 1p R k".1,11,'2111 vs� t L'a" , , , 4, , k" , jig ,, � I��M 4 , ox U, z! `lVA Pot T a�. MW -A, oil I �1 . np"KASUMN jpvj�Afp - U., WS, TOWN OF BARNSTABLE LOCATION �' _ /��f1atavfh �r/�f�y SEWAGE # 0204�—y�Z VILLAGE d3 Ae = ASSESSOR'S MAP & LOT aI'o 'INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILsITY: (type)? (size) � X t . ' NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: 7 2 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 GO c 4 a w Ti Q ' � a Fee -� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE. MASSACHUSETTS es 2pplication for ;h5pogar bpgtem Construction Permit Application for a Permit to Construct O Repair( )Upgrade( )Abandon( ) ss J�Complete System ❑Individual Components Location Address or Lot No. ./\ Owner's Name,Address.and Tel.No. Assessor's Map/Parcel / ��� Agy �(� Installer's Iy e d ,an �OON o. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms ,� Lot Size �sq.ft. Garbage Grinder( ) Other Type of BuildingW z4j No.of Persons 13Showers(,;;�) Cafeteria( ) Other Fixtures Design Flow A r4 P gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 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 Certifi- cate of Compliance has been iss is oard Sign G— Date Application Approved by Date.!:_- - Application Disapproved for the following reasons Permit No. %Z Date Issued ' �NQ ''�, t See Entered in computer: THE C10MUONWEALTH OF i*WASSA�C*H'USETTS 1 1% P es ' A TABLE I,�USETTS PUBLIC HEALTH DIVISION,-TOWN OF B RA .1 MASSAC P 01pplication for Zi.5pogal bp5tiem' ( oti.5truction ermit Application for a Permit to Construct Repair Upgrade Abandon Complete System D Individual Components K, Location Address or L�t No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel ----------1� Instafler'Vs s,and TlNo. Designer's Name,Address and I oe*7, Type,of Building: Dwelling No.of Bedrooms Lot Size b CLsq.ft. Garbage Grinder Other Type of Building 4A!e No.of Persons Shp'wers Other Fixtures Cafeteria Design F1 gallon ay. Calculated daily flow D Flow sferd gallons. —0 Number of sheets Plan Date 'I RevisioWDate Title ' B� �Size of Septic Tank /.74/7 Type of"i Description of Soil Nature of Repairs or Alterationg"(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 accord"ce with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ispec phis Bo � t _� Signedf &V- p� Date /1001-/_ V Z Date Ll 7Z Application Approved b ( Application Disapproved for the following reasons Permit No. -10 :;Z Date Issued --------------------------------------- THE COMMONWEALTH OF'MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY, that the On-site Sewage Di&Fosal System Constructed(k)Repaired Upgraded Abandoned-( by at � b as been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.� 010;zf 9-21 dated 10 Installer Designer The issuance of!��t hall not�becon�struedlas'a guarantee that the,syst, ill tion as,desi Date Inspector ------------------------------------ - --- Fee THE COMMONWEALTH OF..MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSfABLE, MASSACHUSETTS Ziqool 6p5tem Construction Permit Permission is hereby granted to Construct(K Re ( )A an n(,;e�air,( ,)Upgrade System located at 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 must be completed within three years of the date of this Y-eym•it- Date: Approved b f C TOWN OF BARNSTABLEc LOCATION 28 11 s 1moA �4 SEWAGE # a200�—Jd2- VILLAGE �� �„ ASSESSOR'S MAP & LOT a l O INSTALLER'S NAME&.PHONE NO.11944" SEPTIC TANK CAPACITY LEACHING FACILITY: (type). (sine) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 7 U 2 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Si P Town of Barnstable P# _ Department of Health,Safety,and Environmental Services f ` t Public Health Division Date F11100 \I� of � 367 Main Street;Hyannis MA 02601 % wuvaresc$ 1 ate Scheduled x .4.0O Fee Pd. a lE MA'S D Time 1 .,Soil Suitability Assessment for Sewage Disposal 4 Performed By: �u t. v qrV Witnessed By: Iv,t.Q Y1 .�1 D t - a v :.: .. ::. LOCATION & GENERAL INFORMATION Location Address 26►V '�T � �/1V+110 �`+''� t4/ Owner's"Name 'tn lle2S� Address ?_S& G)S�TNomi'e�4o%rLw L�(3S \-1\1COD5 >r t?.1�?S►fl(�.0 , j.0 3 � Engineer's Name (�STLQVt(,t.•C� V✓l A Assessor's Map/Parcel: I Sr.ic tz.s0t.i u.eYa NEW CONSTnRUCTION 1l REPAIR Telephone# q'L$ Land Use 5 kV)Z_N R N L. Slopes p ( ) �'?7� Surface Stones Qp"1l.)z . t _ Distances from: Open Water Body ft Possible Wet Area Wd ft Drinking Water Well. Zo�T ft I Drainage Way ft ' Property Line _ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) e:o �O \\ 2. 2 , P� A 121 Y +r `Parent material(geologic) u t\.0 AS t " Y-A�w \ Depth to Bedrock 3Ly Depth to Groundwater: Standing.Water.in Hole _ A Weeping from Pit Face Kb X 1 Estimated Seasonal High Groundwater t L Z S '�/�� APQ(Zpk 30�C aCt1?.wl fo eA Pt 17 T1✓ I�I l'C3R S Mw- TT✓NAIYJ t Method Used -Tbw n--' BAe-�cew8c.� R-1�tWwA -2KY4fa%0 Depth Observed standing in obs.hole: all in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: dU in. Groundwater Adjustment ft. Index Well#___-.-",-. .Reading Date:,_ Index Well level...,_.__ Adi.factor_ Adj.Groundwater Level 'ERCOIC.rTxON TE$T ' ... :.t Time :©Q Observation 1 Hole# � a Time at 9 Depth of Perc , "1a`i ' Time at 6 256ov-'mow ♦vo LOui't„rVw �., Start Pre-soak Time @ �ime(9 -V) End Pre-soak Rate Min./inch —�`•'s �� Site Suitability Assessment: Site Passed L S Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back-� Copy: Applicant k ' DEEP OBSERVATION HOLE L'OG Hole;# t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency, p —2 P1tU EkEcoL6 zlz A 66" s R fi 'T,SY(IL s13 c0'Alas t)v e. spa o V20 C GowrrsE 1D`!�(L6 (� DEEP OBSERVATION HOLE L;OG Hole# Z,' Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. o Gravel) 0�3 LGaF M&rR '5YA 2/7— ' ^ VK CO SAOjP l SYiQ,4/3 50Nn C— L(S.c.r + caA*e-SA'VD t0'ie sag O A2s6SArv0 l� 5�[oGUEo6e.+vu 1011�2�/6 ' r y .. DEEP OBSERVATION H(tiLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Cusistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soi(Texture Soil Color Soi( Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Flood Insurance Rate Maw, Above 500 year flood boundary No_ Yes X Within 500 year boundary No Yes Within 100 year flood boundary.No K Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? B/F— 5 If not,what is the depth of naturally occurring pervious material? Certification I certify that on A90 L (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 training,expertise and experience described in 310 CMR 15.017. ?U, Signature �_.•.11J�,._� Date ✓�2 .mow _ _- �_ ____ �p.gypqy>�Otp4"Wlb^SBa.+rteliaeM1ESraHi,[:%dYPLF4�s, s...Axsh.ey,{iNdN-LiYi�..J.o:n.a.+.t.'w..lY.uxJ+3.+flJm]4t.L.:'+A�....1..n.a+aus�.a.✓n.:�.,a+.+r+.e..w'..Y:...�....ba......r..,,...dY._�..w.w.s-... a ll �---------- Vt � S 57 . 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