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HomeMy WebLinkAbout0090 FIRST AVENUE - Health 90 First Ave r\(,6 Osterville A= 116-056 1 TOWN OF BARNSTABLE LOCATION 50 i ies-P- Ave SEWAGE# 2011- 39 S_ VILLAGE (nea rg; ke- ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. ERic. SA-Ucyks '�'03-770-105 y SEPTIC TANK CAPACITY 1,4�-60 �Ie� I®��nT LEACHING FACILITY:(type) (Z ( (size) , ;;LS-)c 13 NO.OF BEDROOMS 3 OWNER WkLi PERMIT DATE: i;L14 , COMPLIANCE DATE: illisk 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 leachingfacility)tY) Feet FURNISHED BY 3,azAlz E:.rt � A o n ! Ayx3o Amy 33 No. Fee O *= i THE C MMONWEA�TH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH D!� ISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 1 ftplitation for Misposal *pstem ConetrUttion 3permit I'6 Application for a Permit to Construct( ) Repair( ) Upgrade A/) Abandt( ) ,XComplete System ❑Individual Components Location Address or Lot No. .90 F/,e ST ✓ 2yer�N�am�Address,�d T��`����A Assessor's Map/Parcel /ylfl/° i /n • 368" -.32. 8'- D / G 79 Installer's Name,Address,and Tel.No. �El2xc- D vt DNS Desi ner's Name,Address,and Tel.No. ✓,. a y[,E i4ssa��.9-TEs sa8-S'G3/�9 P.6'8W Wtars�ar\S hells MR- S08-77&-10S /7a Type of Building: Dwelling No.of Bedrooms 3 Lot Size /7 0/b sq.ft. Garbage Grinder( ) Other Type of Building R&J"Id)&/NCB No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,5 D gpd Design flow provided ,3�L$ gpd Plan Date %/— A - // Number of sheets Revision Date Title �iL✓�9-� /®L�- �.� �� �i�/ /��/� Size of Septic Tank J ®Q 6,4 L Type of S.A.S. ZS-'X/2��b C/ �M B6,4 V17�MJ Description of Soil_Q-�q S��IJ j)is L d A-ly 9�'�� � L•d�9�'1 N �/9'�I/�Cl 30— )3 2' dh t- / -5-,0-W,,6 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 h. Date [ Application Approved by Date �--- Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------- - ------ V NY' o No. _,. '°`sue; Fee THE COMMONWEALT H-QF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN"OF BARNSTABLE, MASSACHUSETTS 1 *Piication for Misposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Aban 'IT')4'ACompletc System ❑Individual Components F Location Address or Lot No. .•94 /9'/4 S> �� w er's ame,Addr s and Assessor's Map/Parcel A/° /�G �AQ i� SP2;/✓.,-F/Z 1)9 - 326 - 32 8' - 079/ Installer's Name Address and Tel.No. 12kC. 5Afv C,�jS Desiggner's Name,Address and Tel.�..I�DYC..f /�ISSOG//tT�s 508' SrG3'��I9 pC�. '1� 4�n�rs�o�,5 1nEl\ YYIq, 508`T7�-�aSN 176 Coo✓FrzF/�L� I�v�9 �..�,4��orJ>h� TI pe of Building: Dwelling No.of Bedrooms S` Lot Size /7 0/b sq.ft. Garbage Grinder( ) Other Type of Building 26S/j wCC_ Nov of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 gpd Design flow provided .3 8 gpd Plan Date �/- g " /� Number of sheets Revision Date Title Sr/T��ftCG✓�16 C /�L+V /DZ. Qt)L_✓¢ 4941 7-11C-/L-. Size of Septic Tank e�0 64 L Type of S.A.S. Z s �A' 2//D �'/-//q /N B r✓L Sys T�i'YJ Description of Soil -9 '.5/J/i W y L D,4-1y ,!7' --3 , SW-.✓A Nature of Repairs orAlierations(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 o ealth� -. o 0 Date 1 I -►S I 1 t Application Approved by ! _ Date Application Disapproved by Date for the following reasons Permit No. 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 ER 1 L Sl-"LJf�J`� at qa F rJ Ove- c yv,\ie_ has been conIn dame with the provisions of Title and the for Disposal System Construction Permit Nog ted Installer ��t F�ST6UC,N Designer #bedrooms Approved design flow gpd The issuance of this permit shall note construed as a guarantee that the syst(er`ii will fuon a si n d. Date J 1 Inspect'© !- _. No. D Fee ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( )1 Upgrade,() Abandon G ( ) System located at 10 7 tf S4 five . QStcd J i kki ol 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. r Provided:Constru ti Just be o pleted within three years of the date of this permit. / If r Date ���/ 71�� Approved by NOV/18/2011/FRI 08:51 Alba SandwichTownOff ices FAX No. l 5C8 833 OC18 P. 001/001 Town of Barnstable .°�'Ne Regulatory Serdces Thomas F. Geiler,Director t 11AMT96f'JiHLE, Public Health Division Thomas McKean,Director - - 200 Main Street,Hyannis,NU 02601 Office: 508-962-4fir Fax: 508-790-630 Installer.&Designer Certification Form Bate: Sewage Permit#266- 39 S' Assessor's Maff arcel �t Designer', i Tustaller• EPlc S►fVEA) Address: 1 Address: _?(D. ?c)x 1 1 #"10144V I �. M�tQsra n►S y�ice« On l /f sElf I L STfv£,vS was issued a perzxtit to install a (date (installer) septic system at - 4 1V fAJ Le_ based on—a design drawn by ii (address) t � �� • . dated (designer) 1 certify that the septic system referericed above was installed substantially according to the desrgn which may include minor approved changes such as lateral relocation of the distribution box andlor septic tank. -1 certify that the septic systems, 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 certified,as-built by design er to fallow. \ DA E M u+ Y •� f (instal is Signature) 14 I (Designer's Sign true) V (Affi.x Designer's Stamp Here) PLEASE RETURN TQ_ BAMSTABLE PUBLIC HEALTH QIVISION, CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FOF211I AND AS-BUILT CAItI) ARE kIrCEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVXSIpY_THANK YOU, Q:Hearclu'SepciellJcsi�er Certifxcacion Farm 3=26-O�doc Town of Barnstable P# t^3 14 io-5 Department of Regulatory Services �xn�arssr,E, Public Health Division Date_ i oMAM 1 � L i6J9 `6� 200 Main Street,Hyannis MA 02601 Date Scheduled l/ //� Time / ` Fee-Pd. Soil /Suitability Assessment for Sewage Disposal Performed By:��� N .P• U� G�� /� .. n ! � Witnessed B LOCATION & GENERAL INFORMATION Location Address '0 FlRST 4 VC Owner's Name 1�0141,44_6 Address SAQ//v6/C/1',—1_b 6//0, Assessor's Map/Parcel: b lo P�RC Sb Engineer's Name �/� DoyLE NEW CONSTRUCTION REPAIR Telephone# Land Use.2 ZE57 D AL SJAorCt,�> Slopes Surface Stones /tl67' D�<5�.�✓L�,b Distances from: Open Water Body �d ft Possible Wet Area Z ft. Drinking Water Well� ft Drainage Way. /U ft Property Line /0 ft Other ft 4. SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 93� 23 ' 29 N D p Z+' l �9" G ✓�s, �t fiRsST q vr-n/v r Parent material(geologic) m SAAID Depth to Bedrock. /! Depth to Groundwater. Standing Water in Hole: //0 A/E Weeping from Pit Face N Estimated Seasonal High Groundwater 6 L E V 3 9L Pl'iQ Ali—L CA, COAt j0 41& /DAP 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 ley a AdJ,factor_ Adj.Groundwater Level PERCOLATION TEST Dgtpl/ 3 tiThne Observation Z Hole# Time at 4" /���i•<�� � `— it ai f -"t Depth of Perc �� _✓ Time at G' / ' �U -- -^ --_--- OU Start Pre-soak Time @ I' l OD Time „ ,1 End Pre-soak P 3? ' BD Rate Min./Inch 2 IY7/ ► r r t�37 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. Barnstable Conservation Division at leist one(1)week prior to beginning. Q:\SEPTfCWERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on istenc % ravel DEEP OBSERVATION HOLE LOG Hole# '2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsi ancy,%Gra.ve y 4 s .71 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi to c 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, 1 t Flood Insurance Rate Man: / Above 500 year flood boundary No Y __V Within 500 year boundary No Yy", ' Within 100.yeartic�A boundary No Yes Depth of Naturally Occurrint=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? tr 5 If not,what is the depth of naturally occurring pervious material? „__ Certification I certify that on T (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 tr ' ing,experttiiisse and experience described in 310 CUR 15.017. Signature ,dJ Date�/ 3 Z a � '� Q:\S.EPTIC\PERCFORM.DOC Town of Barnstable Pit t^3 4 6-S � Department of Regulatory Services Public Health Division Date ti61q ,�� 200 Main� Street,Hyannis MA 02601_ Date Scheduled �� l/ -�0 o Time / Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed By:-,��A ./9• 00��� � Witnessed B}!���U LOCATION & GENERAL INFORMATION Location Address - A Owner's Name �b 6 /1 10 114S7 C L Z- E 967 kV 144,e41,14 n Zb . Address J o-;m5 C-6 6l/09 Assessor's Map/Parcel: _j;4 Engineer's Name '14.00 y L E NEW CONSTRUCTION REPAIR Telephone# 5'"6�-S"l3-l99f Land Use C—Al7j /J2IV 4- Slopes(%) Surface Stones I'V47- ZMJ-6-1—VZ-b Distances from: Open Water Body !.)Cl ft Possible Wet Area 4 ft Drinking Water Well ft Drainage Way IV 4 ft Property Line 1/0 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 9s, Z-3 ' i i 29� �► rp- 1 z /D0� fJ G /6) 80 v Parent material(geologic) 1 Depth t0 sedroclG 1 Depth to Groundwater: Standing Water in Hole: /V 0 N C Weeping from Pit Nee � ✓� Estimated Seasonal High Groundwater c L E V, 3• y e;rR 66rU Q1 `, /L L N/L COAtra dA, InA P 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.�;� W, Adj,factor--Adj.Groundwater Level PERCOLATION TEST Date/ 'x'hne /0 04 Observation _ r Hole# 7 Time ath" /1Y?�rsi� Depth of Pero '�1 Time at 6" r �v ✓' Start Pre-soak Time @ /` ! O D Time(9"-6") End Pre-soak 1 i 3? Rate Min./Inch 2 1)9 / 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. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTfCWERCFORM-DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency.% ravel 7-v AL DEEP OBSERVATION HOLE LOG Hole# ' 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C psis en % ravel 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. l Flood Insurance Rate Map.• Above 500 year flood boundary °No Y's . Within 500 year boundary No,— Yes Within 100 year ficwl boundary No Yes Depth of Naturally Occurrinr�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? 16 S If not,what is the depth of naturally occurring pervious material? 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 tr ' ing,expertise and experience described in 310 CMR 15.017. Signature -W ,lam— Date Q:\.SEPTICIPERCFORM.DOC u _ ..:... .. � ....H. .::. '. ., .. ,-, .. ., , 4. _, l.y.�. .. ,, a ,,, ...,:. .: .�,,.. .:: " ..,, .°i ria .. .. �, f. S ,. ,�. .. 1'.; .:.„ .. 4 ,... t ,.. Sh w4 I_ r r— 1 r t r , I 1 f r L 20 fk 3a -_.—.- i R Ml �kpN.. L.__. ... .., i :I , , 1 �f I = _.._.. L 1—1—!1 — _-.- k ) r -- -- �_ IT 7_..f I rr..—1 1 I ---�— , � , -J• x nru I� �I � - � .._1... __ _ -I-'-r1—� /W n :nn . 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L ofJNJ y [ o AM A RISER W--476RTI6HT COVEi2 9 MIN• cove 2^' COVER OF B SAAI.6 Q y SAni d " SGH. 5�0 PYC 36"MfiX iSER STONE 7 SCR �f , 7 5 YR ��SI EL. 2 9.i /N V, L/4U/D LEVEL 1 SCN �D PVC y�'" 0 SCH- *D PVG /NV• 2•-g.7° 36 EL.28.7,9 3cf 7 /tiV /NV. /lvv, 62) Soo GAL.• N-i'Q LEACH Cf/AMBERS y ' 2 g. 7 7 �O"MIN, ��}r Z 9, 1�7 2 9.0 /NV z$, 9 Q 31,h' -/�Z ` CQ C[ L� 1"- 7 C1 CJ L] C� l� 31* /12'' 1 Jj O!/.SL E 5 LEVEL 1b/5T. ,BOX WAShNEa sToNEED 2 EFL p ��fiE 57'Al3L.E ►�/�G „ -UMP• DEP7 BAF eA,5E e'er /2"M/N. /NNE.e cev�NEo /HENS/oN `f / 'f M E,o/�14 sro.�/Fs. M E.D/UM 6„O` Z5 C SJA AND C S/9/ )D L'SE /l3EGi95T Go,vc, /Sap G,9 LL ON " So/L S /8SORPTION SYSTEM 7, 5 YK /�� 7.5YR 7194 SEPT/C TA/•/f� W/TN /it/t-E�O UTL E 7" TEES CoNST.P(1G?E 1� ,°ER 3/D CNj/� /S: 227 y-e ,'VDU/' 57 024 6 e -- 330 x ;l - G G D GyLLONS , BOTTOM 4F 7c'ST //T ,SELVAGE SYSTC-M DES/GN c�9L CUL,9T/oN5 = /, .DES/GA/ D19/LY FLOW = F/N/Sf/ 6R,4.oE / • 13 2 2-0-7 /3 Z" 1 1EL, 2l_ / 2. 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