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HomeMy WebLinkAbout0049 MILNE ROAD - Health i 49 Milne Road Osterville A= 118-019 I TOWN OF BARNSTABLE LOCATION �9' /�/�� ®. SEWAGE# VILLAGE �3.�'� �� ASSESSOR'S MAP&PARCEL-00�P 0/9 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY "S—o® 69:de LEACHING FACILITY. (type) (size) '00-7 NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: to 13 l U Separation Distance Between the: 4, >° 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 R E04�AtNI)k No No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS VYe Zppgicatiou for Migpogal 6pgtem Con.5tructiou 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 Mapf.Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. d ��-s`ono> 442 4/iow ' 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) gpd Design flow provided �p gpd Plan Date _1'::> Number of sheets Revision Date Title Size of Septic Tank >v f,�E�i ./�'o o Type of S.A.S. Description of Soil ��.�'"ota �y'„(�Cow✓ G o rG��'T�' 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 d of Health. Signed � tY Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. Fee /�10 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Vy_ ( PUBLIC HEALTH DIVISION.-TOWN OF BARNSTABLE, MASSACHUSETTS pplication for Mi!gpk�il *p5tem Con5truction 'Permit Application for a Permit to Construct O Repair( ()� +Upgrade( ) Abandon O Complete System ❑Individual Components _ 1 Location Address or Lot No. Owner's Name,Address,and Tel.No. Assessor's Map/Parcel /J ef', 0/9 1i'®T P-- t Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size i., sq. ft. Garbage Grinder ( ) Other Type of Building i�f No.of Persons Showers( ) Cafeteria( ) Other Fixtures 0 Design Flow(min.required) .. gpd Design flow provided 0 gpd Plan Date 4:2 Number of sheets Revision Date Title Size of Septic Tank !v er Gy /✓"cr o Type of S.A.S. TQ'-�i�G1q' /��d.i�s�)►io Description of Soil Nature of Repairrs or Alterations(Answer when applicable) S� '/'l0/'L`/4hZ'�v N s� 11 Y J Date last inspected: 1 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 - d of Health. Signed m at �"- 0 Application Approved by � DateIV Application Disapproved by: V Date for the following reasons , 1 i �4 en Permit No. / (J Date Issued I( / vff *' - - -- ---c -1-- — -- - -r - - - - --- - -1-f- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS - (Certificate of Compliance <¢ � THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded k') Abandoned( )by at 5' /ylyL.✓ 4E'�- ©J'7 has .een constructed'n Aordance �- - with the provisions of Title 5 and the for Disposal System Construction Permit No. CW16 ated Installer �� G t'�e�Gy.�' Designer 40-4 yi.0 . /�i�/+`�O/� ;Z-r #bedrooms Approved design floe .3�,�/� gpd. The issuance of this perip it shall not be construed as a'`guarantee that the system I I fu cGi n as designed e Date b'I I. U Inspector . , No. '" t! Fee I� HE C OMMOl�WEALTH OF MASSACHUSETTS Skt".--0 C II kl TH DIVISION-BARNSTABLE, MASSACHUSETTS i� 'odor 4bp5tem Con.5truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (><) Abandon ( ) System located at it 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 ust be completed within three years of the date of this pen L Date I,/ �ll Approved by A David B. Mason, RS 4 Glacier Path East Sandwich, MA 02537 �J 49 Milne Road Osterville, MA October 7, 2010 Town of Barnstable Board of Health To Whom It May Concern: We purchased 49 Milne Road in July, 1982. It was sold to us as a three bedroom home, and it remains a three bedroom home. Respectfully submitted, Patricia E. Ingraham John Ingraham • Oct 15 10 07: 50a Colleen Mason _[508] 833-2177 p. l Town of Barnstable Regulatory services 0 Thomas F.Ceder,Director Public Health Division Thomas McKean Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508- R¢ Installer&Desil4ner Certification Form Date: VCYJPJ� Z�C�D Designer: Installer: ���'� L�"O&)F Address: . �'�1 �(, Address: ' -_ f y s S On �O / /d �1 SDI was issued a pert it to install a ( e) (installer) septic system at '�'� rll�� �i a5 LUe based on a design drawn b (ad dregs) y dated ,designer) 1� l:certify that-the septic system referenced above was installed sabst auttaIly according-t `.lie design, which may include minor approved-changes such as lateral relocation of th 61ftdbution box and/or septic tank. I cerfif3 ;that the septic system referenced above was installed with' a3or,changes (i e greater 40' lateral reloeatioxi of the SAS or-any vertical:ieiocafiion-of any componex of the.septi-system)but jja ae ordance with State&Local:Regidations. Plan revision c certified as butt cy des,h*to follow. -- - - _ s DnAV Adt9rer"s Signature) �. MA ON 0o,1066' 1T0I�'� (D er s Signature} (Affix' igner's.Stamp Here) PLEASE RETURN TO BAR&gTAI CX FUBLAC-HEALTH DIVISION C A-ff-V Ol' COMP ,IANCE L'NO E = SIIED U t L BUTR•TOK FORM-A;1�j A5; BUILT LARD ARE RECENED BST BARNS`ICABLE PaUBI�C ;TH DIVISION, T3 A Yt�U: Q:Health/Sep is Desi.-*Certificab6o Fon-, - Town of Barnstable 1 P# f 3 o y Department of Regulatory Services a.Rwa,..�.,as Public Health Division Date 1639. 200 Main Sti-eet,Hyannis MA 02601 r Thy Date Scheduled Time 1 Fee Pd_ 5, Soil Suitability Assessment for Sewage Pisposal Performed By: ' /'6�1% V"� Witnessed By: 4�, t✓- LOCATION&GENERAL INFORMATION Location Address /L�G� 'Oew, C J . Owner's Name _.Z_A-6faZ411-4 Address -P 9 -.40/Z Assessor's Map/Parcel.- /p Engineer's Namel�'e�/� NEW CONSTRUCTION REPAIR Telephone# ja} y Land Use 1 )(;kJM 4f V Slopes(%) Surface Stones' Distances from: 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 i'n proximity to holes) �Z I / � � � 41 Parent material(geologic) v Depth to Bedroc PO D 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: Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well lever Adj.factor - Adj.Groundwater level PERCOLATION TEST we , Thne. Observation � I Hole# 75me tit 9" Depth of Perc Time at 6' Start Pre-soak Time Time(9"-6") - End Pre-soak 1ki I ' - Rate Min./Inch �'�t. i• ' Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) t 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:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color, Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. oniteGravel) l DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon s: Soil Texture Soil Color Soil Other Surface(in.) '(USDA) (Munsell) Mottling (Structure,Stones,Boulders. . Consistency.%Gravel) F ' 6 • , 6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. on ' « l 1 Flood Insurance Rate Man: Above 500 year flood boundary No Z Yes . Within 500 year boundary No Yes No Yes , Within 100 yea r flood bounds ......�._ Y boundary Z of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe i aterial exist in all areas observed throughout the area proposed for the soil absorption system? p r� If not,what is the depth not ally occurring pe coos maeerial7 :..�. Certification I certify that on 10 (date)I have passed the soil evaluator`examination approved by the performed b me consistent'with . Department of Environ a to Protection and that the above analysis was pe Y the required training,exp 's d xp rience described in 310 CMR 15.017 2 1 Signature Date Q:\SEFT MERCFORM.DOC ASSESSORS MAP : ��g TEST HOLE LOGS NOTES: � PARCEL : � / �o� � ��C��� SOIL EVALUATOR : �1A�/1pj, FLOOD ZONE: 1) The installation shall comply with Title V and Town of Barnstable Board of y WITNESS 9A\/lt✓� Health Regulations. Cam` REFERENCE: 7-F— -4 635l7C3 DATE: 1��, (O l(� 2) The installer shall verify the location of utilities, sewer inverts and septic J PERCOLATION RATE: z D' j( ,,4 , I components prior to installation and setting base elevations. 9�, ;> 1, 7 / Zj 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first 7 �9 �� �- �� two feet out of the d-box o chin shall be level. / TH- I TH-2 t the leaching � A �� I I� 4) This plan is not to be utilized for property line determination nor any other 1 , Z �� purpose other than the proposed system installation. 5 All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. i �by � �Z ✓, 1 > Z 7) The property is bounded b property corners and property lines. i3 ��J' �MW 8 The property owner shall review design considerations to approve of total LOCATION MAP ) p p y g Pp �� , SIQy►� I Sit,��) design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. I I 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per ,�Z - - �Z ►� _._ Title V specs. i 10)System components to be 10 feet from water line. Sewer lines crossing the ?qAco (_'v water line shall be sleeved with 4 inch SCH 40 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service SEPTIC SYSTEM DES I G N 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 FLOW ESTIMATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such BEDROOMS AT �0 GAL/DAY/BED 0 M -,i/yGAL/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 - UD GAL USE GALLON SEPTIC TANK SOIL ABSORPTION SYSTEM Of i I I DE AREA: ZX � BOTTOM AREA: -2 l X v AA--77 ]= 2 , = j DAVID cn f � SECTION , • 5, �'fST��P� � i k\SEPTIC SYSTEMAfw ,, X O OT or- Aii \ C _ ,z �W1x• nLOG%t-riV O )pq-r�it,4tT 6"SiT�I� O 1 _b 5 - Ft OR �co�1PpQ — — DA II " m " �U�1 ' I�DO GAL ��p, - - 2 ~— 1)2- qlD SEPT I C TANK ° 1, CtrW `� 3 1 ► ' -21A ------- --------------- _ _ - 3 0 - -------- - - — ��l �ylr> SITE AND SEWAGE PLAN \ - — LOCAT I ON : 43 T - ?-6 Q PREPARED FOR : I � D6Vr � L 44G I A SCALE •L tzo' DAV I D B . MASON P� DATE: 0 z — - -- DBC ENVIRONMEN AL DESIGNS w o r EAST SANDWICH . MA �'� I✓ ` DATE HEALTH AGENT 08 ) 833- 2177 l0 5 Flo r'v'