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HomeMy WebLinkAbout0033 OLD MILL ROAD - Health 3 • 33 Old Mill*Road Osterville • u 141 042 �,'. .. •.. a �. � ., ,. , s, 4 - . n V � a t. f ✓ .n ;? ..� Y ❑ f, n r { KJ ; n '' A v rV 2 ,A fr tl•c ° h � o - i r ' 1 a 0 ` rA TOWN OF BARNSTABLE LOCATION 3 O/W SEWAGE# 0200,7 Sa Z VILLAGE ASSESSOR'S MAP&PARCEL /y�y INSTALLERS NAME&PHONE NO. /��! fir.yc�l:�., e/77-o4-.:5 SEPTIC TANK CAPACITY LEACHING FACILITY. (type) 5 oo-579 size) J3 NO.OF BEDROOMS 3T OWNER n Kti h PERMIT DATE: //��/ � COMPLIANCE DATE: // �02 q /0 7 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 ,4�-�,6 ' :;4f i,t33' A� I -s3.G . say ' AS �' • 87,6 0 ® 3 No. Y Fee ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppiication for 33i5pozat *pftem Construction permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 3 Q LD M I L.L_ ROA Q Owner's Name,Address and Tel.No. 051-59V I WE 50E q le-A m e Assessor's Map/Parcel AAAP 141 ?AeLF-- 4 3Z QLDMILLeD Q.5TFj?VlL1Z_ AAA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i�OblEeriSiIl.Foy- 3+6 F_KLFNAT1aW -DA0110 AAASDPL Sa�-833-zI-17 14 1"EA8Zk?N W. D Q L 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 33 D gallons per day. Calculated daily flow gallons. Plan Date 1112-6101 Number of sheets Revision Date Title5 Size of Septic Tank I 2 I 7 Ah 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 h?gjz s ed by"thisard of Health. ed Date ►I I d Application Approved Date 1 )-i Application Disapproved for the following reasons Permit No. Date Issued 160 No. E= av' � ;�.. �":�4}Y.,. � -. ;�a,� '1 -�. 44 Fee THE C.pmmbNWEALTH OF MASSACHUSETTS �f Entered in computer: t;;. Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zfpprication .for ;3igo5al *potem Con,5truction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. -j 3 Q L D MILL IZ U A(D Owner's Name,Address and Tel.No. Assessor's Map/Parcel M/-NP Iy 1 ?AeLLL .4-2 33 ULCJ M►LL eD US1 (? I t l - AAA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. h �Ubf_e-r C-iILFvy. 73i a _DAV 10 &. A,5t,, t l 56,� k 33 �i't7 � `I Tti\B,5Pe\ LM iUe[5-1D�L �-�ANi vLY�tiMC AAA �LsIt7rU � Type of Building: Dwelling No.of Bedrooms 13 Lot Size sq.ft. Garbage Grinder Other 'I,pe�of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow - gallons. Plan Date i 112U I u 7 Number of sheets Revision Date Title S I e i S2 v c C (Ca Size of Septic Tank I S�-�7� I o d.L it, h1e 7, UJr(V Type of S.A.S. Description of Soil PC Nature of Repairs or Alterations(Answer when applicable) G Date last inspected: k -Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system Y 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 - 'slued by this Boar�ofHea�lth. igned Date Application Approved b. Date f+� `a-/P-7 Application Disapproved for the following reasons t Permit No. r Date Issued I ` 0 S,AS IIJd�r1�7 ' �� --THE Ct,!!AM©NWE:AI_TH'OF MASSACHUSETTS----------- BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( '' Upgraded( ) Abandoned( )by I�U "�f-2.1 6 l L F _3 X I A\i ►j at 33 OLD MILL ST` 2 0 11 L- has been constructed in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No._ 7 7 dated / ��� Installer .E I L U\. ' Designer I_)kQN C) MA S L I7 /V a, e The issuance of this e t 'll not .e construed as a guarantee that the sysr'tm will-function as designed. Date Inspector —�r-- ���------------------------ No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi5pont *pgtem Con5truction Permit Permission is hereby granted to Construct( )Repair(VII-)Upgrade( )Abandon( ) System located at 3-,7) 0 L D AA ,L t_ 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: Construct' mustacompleted within three yeas of the Bat sperm I OrI7-Date: Approv dby f TO' wvn of BarnStabJe' o Regulatory Services Thomas F.Geiler,Director . - Public Health Division �a. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.S08-862.4644 Fax: 508.790-6304 Installer&Designer Certification Form Date. O . Zy Designer: Installer:. bra+ C 1 oT�-r8 EY,c Address: . Q�AI-H Address: rry R �2. On f I Lt �0-7 L LVOY. was issued a permit to install a (date) (installer) septic system at V111,U Qb based on a design drawn by Y p� 't0, MWOD4, � dated I i�-4o l 0 7 (designer) ../1-certi y that the septic system referenced above was installed substantially according't) "fie design, which may include minor approved'changes such as lat ltelOcatiofi of th. distribution box and/or seWc t . 1•_cerWY fat the septic system referenced above was inat4ed with'`.n�a changes (i�e. greater tl `1 U' lateral relocation of the SAS or any veatical-'relora'i�+n of any•componen t of the septi6jgystem)but in-accordance with State&Ucal.Reg lotions._Plan revise o� certified as-1 " t'by designer to fallow. V !'•. . (Installer's S e) MASON + (D er s Signature) { P r+✓) .........--...- PIEASH+ RETURN TO iB t U'I' I, "IMALTH D OF: QW1 LLANCE I3UIIJT 9 ARE tECED '�(E.R Q:Health/Septic/Designer Certificafiipn Fowl .4 Town of Barnstable P# Department of Regulatory Services . MA , r Public Health Division Date 200 Main Street rpyannis A 02601 1� � . Date Scheduled e Fee Pd. Soil Suitability Assessment for.,Sewage Disposal Performed By: � QS. A 146oz_j Witnessed By:22)Ot-J"J01 N 2*101 t._ LOCATION&GENERAL INFORMATION Location Address._ %.,3 Q LD M I L•L..PqD Owner's Name Teq r ' e OSTERV I LLBLorr Address 53 D LD M 1 l..(_ eD 05TF_?_V I UE7 Assessor's Map/Parcel: )�j 4 2 / Engineer's Name DA V S 0 O NEW CONSTRUCTION REPAIR " Telephone# 5 09-3 1 Land UseSlopes(%), _Surface Stones�'a�Y� .4 Distances from: Open Water Body ft Possible Wet Area �— ft Drinking Water Well ft Drainage Way ft Property Line I— ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) rr��`-''7V Depth to Bedrock Depth to Groundwater. Standing Water in Hole: N Weeping from Pit Face AIA- Estimated Seasonal High Groundwater 1 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 : v._e. Adj.factor, _ Adj.Groundwater Level„•e Observation PERCOLATION TEST Dgte , Thne Hole �J_ Hole# 'Time at 9" Depth of Pere CS `Time at 6" ti Start Pre-soak Time @ j ! _ �. Time(9"-6") End Pre-soak 1 /S 41, s � Rate MinJlnch Site Suitability Assessment: Site Passed Sitc Failed: Additional Testing Needed(YIN) p Original: Public''Healtl l)&ision\ ��, 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:ISEPTICIPERCFORM.DOC i 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 %Gravel) •c�c7 ��/D �T�/L., DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) 'Mottling (Structure,Stones,Boulders. nsi ten %Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface On..) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) i DEEP OBSERVATIOKHOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. t Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes y Within 500 year boundary No L Yes Within 100 year flood boundary No � Yes 1 q, Depth of Naturally Occurring Pervious Material t • _ Does at least four feet of naturally occurring pervious ma ri 1 xist in all areas observed throughout the area proposed for the soil absorption system? /0 o L If not,what is the depth of naturally occurring pervi s material? ` �65, `'�� —7-� Certification ' I certify that on �d :tal (date)I have passed the soil evaluator examination approved by the Department of Enviro m Protection and that the above analysis was performed by me consistent with . the required training,expertise and exp rience described in 310 CMR•15.017. Signature r Date «/2-6 Q:\SBPTICwERCFORM.DOC r „ LOCATION SEW&GE PERMIT U0. DO VILLAGE IWSTALLER5 W&hAE ADDRESS PU L ERS ►JAIvIE" ADDRESS 14-6-60 DL'TE PERII-Al-T ISSUED D &TE COKAPL1 W ACE - 1 r To 14003 i , ,� Pr No.. .:f.:.. ......�� Fin.... :................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF H TH `1 -.-------- ---------- Av ® Appliratiou for Diopviial Works Tomitrurtion ramit \� Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: .... . .._. ::2. etl!...� e --------D ..---- .....o.r t No. ..................... L Lion-Address ...... ............................•-- Owner Address =----•---- ..................................................................................................--•-•-•••-••----------------•---•---.•••... ....-••--------•------...----•-............ Installer Address dpe of Building/ Size Lot............................Sq. feet DwellingZNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures ----------------•----------------------------- W Design Flow............................................gallons.per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-_______-___-_.-__-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Tq Test Pit No. 2................minutes per inch- Depth of Test Pit.................... Depth to ground water........................ a ----------------- •----------------------------------------------- -.......... ---.-----------.... -•-------•--.........--•--•...... O Description of Soil........ U -•-•---------••--•-•-------- - ------------- .......----••••-•-••-•---------------•----•--•....... -•------------------ -- ......................... -------------------------•----.......---...----------- G''... �J_ V Natu e f Repairs or Alter tions—Answer when applicable.__..,�.:._.X 1' *46— _ ......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t e board of h th. ,.,(a��ignne ... . .. ..... ------------ r Date c - Application Approved By....... ..-----•--•• = 7 Date Application Disapproved for the following reasons:............................... -------•-•------•----•--••--------------•----•-•.......--••---•••••------ .......................•-••-••-••-••--------••-----•-•--•-••----------._...------•--•---•••••-••--------•-------------------------------•--------•••----••----••----•----••-•--------•-•••------------.. -7 ,.� Date P � PermitNo...................................................... . Issued-------•................................................ Date No.. .%!j ...... Fimiz ,�'. ...... s .< . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HFS TH -------------7; -- ­ ---+C .. OF..... . : _ ................... , Application is hereby made for a Permit to Construct ( ) or Repair ( Individual Sewage Disposal System at: ............::... c .. A............. Lo ion-Address or No. ;, ... 4"c„'..a.m... y�'1.1i�+.:.......•........................ ..•-•-•--•--...-•-•-•-•-----......._....-•-------...-•----•-----•-•-------........................ Owner' Address = .... .. x........ .................. Installer Address Q e of Buildinv Size Lot.................... .....Sq. feet U Dwelling No. of B'edrooms.............::.............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons............................ Showers — Cafeteria Otherfixtures ----------------------------------------------------------------------------------------------------------------------------------------------------- WDesign Flow..................................._:.......gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity °gallons Length _______________ Width................ Diameter................ Depth................ Disposal,sposal,Trench.—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..._..............sq. ft. Z Other Distribution box'( ) Dosing tank ( ), ~' Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.......................... ------------------------------------------------------------------------------------------------•----------------------- Descriptionof Soil--------.. . ... -----------------------------------------•-•-------•----•--•----•-------------------....------•-••------------------------------ U --•----------•-•-----•--------------•------••-- ---..........-----.....----------------------------------------------------------------=---------_.... _ -- ----------------••-•---------•-----------------------••.....----•.---• --•---------------•---- -- --- -- - U Natu-e f Repairs or Alter tions—Answer when applica.ble------f ^._I �ll............ .... .. .;; �-------- -_----------------------------------------------------------------------------- ---------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to ace the system in operation until a Certificate of Compliance has been issued by-tl e board=heh.. ign �! Date Application Approved By....... + --------- '.. a'Y-' Application Disapproved for the following reasons----------------- - -• .............................. .............•-------.....-------------•---•---------------------------------._....-------------------------••------....--•-----------•----•--------------•-----••---------------...... ............... Date PermitNo.......................................................... Issued........................................................ Date THE COMMONWEALTH OF' MASSACHUSETTS BOARD OF HEALTH 00��f� f rF.........OF....f.+ ................................ of (111utplianrr 45 T IS IS T SCR , That e Ind>vidual Sewage isposal System constructed ( ) or Repaired ( by=r `--- - •---------------------•----..........---••----------------------------...---.... .� 4nslerIns ler ' x at has been installed.in accordance with,the provisions of Article Y,).,I The State -Sanitary Code as described, in the` application for Disposal Works Construction Permit No------ �_ -----« y dated- -",. ... '` ......... THE ISSUANCE.OF TFIIS'.CERTIF'ICATE SHALL NOT BE CONSTRUEP AS A GUARANTEE 'tal/4T THE SYSTEM WILL FUNCTION SATISFACTORY: x DATE ................................................................. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS qY, BOARD OF HE LTH } a '" :......O F. ... - N '. ., FEE """,. �...... Permission is hereby granted--- G ......Vez- ---- - 1..................... to Construct ( ) Re ai idua D sal System at No = -- '� - ,�. Street - ------.�..�..... as shown on the application for Disposal Works Construction Pe it o__..._. ..,� ted.. ..... 'I' ----.------- N Boar of alth DATE ..................................................................... ,,: "��FORM 1255HOBBS':& WARREN, INC.. PUBLISHER$. - r �M1 e Al S." T ASSESSORS MAP :, �___ ___..__._ TEST HOLE LOGS NOTES: Q PARCEL : ,'12 l MA FLOOD ZONE: �/� �l�C 1C' IL. SOIL EVALUATOR: / �I 1 The installation shall comply with Title V and Town of Barnstable Board of l- ,�,� — .__._._.. _. min ... WITNESS : ► wo Ib ) P Y I �S �`��� �� �� � Health Regulations. REFERENCE: ct3� f� DATE: h4C1VY' u q PERCOLATION RATE:. 2) shall verify the location of utilities ^— _, , _r . /_ .� 2 I 1 M The installer sha y , sewer inverts and septic components prior to installation and setting base elevations. /' _ .......... ...�_ ,..___.. � �Z�'•�^ ,�, I2, \0 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first C7 TH- 1 TH-2 two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other ll 3 { /o 3 purpose other than the proposed system installation. �Z tit Cb �J 5) All septic components must meet Title V specifications. 6) Parking shall not be constructed over H10 septic components. 7 ���� 5 U► � � 7) The property is bounded by property corners and property lines. 3 `' • ' 8) The property owner shall review design considerations to approve of total g flow and number of bedrooms to be considered for design. Receipt LOCATION MAP C��'r��/ design t g P of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material 10 d per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean washed NO (tow), u�jYi,,,+ 1�2 q ,RW sand per Title V specs. -.--' 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 v . applicable. S E P T I �. SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the owner to ensure such. FLOW ESTIMATE 12)The installer is to take caution in excavation around the gas line if .__.� applicable. BEC�ROOMS AT GAL/DAY/BEDROOM -3 GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer >pe6 ,�-, lines exiting the dwelling prior to the installation. SEPTIC TANK 14)Access for installation of the proposed septic system will require access permission from abutters. It is the responsibility of the installer and or / 3�70 GAUDAY x 2 DAYS - U51D GAL w owner to obtain access permission. (� USE GALLON SEPTIC TANK ' �.` SOIL ABSORPTION SYSTEM Lj 2-X SIDE AREA: '�`� 6+ Ir �(2 C?� /Dy ": .►ta N BOTTOM AREA: 2 ��� D' t SEPT I C SYSTEM SECTION (Ai :. ' W S 1 I , A q 2L75 1�7 5� 11 0 •. ��a:1; - / GAL gq lA� .'" ! V-l SEPTIC �r A)e w (SLR a 1�un b '►� p 3 a S 1 TE AND ' SEWAGE PLAN LOCATION : 4 - ►l,(,, �aJ o PREPARED FOR : ICVI�A KVI �4E C`.. W'LieE+ \ MA 0 SCALE:W. = CL f DAV I D B . MASON DATE: i) o : � R o �� �� T DBC ENV I RONMEN�fAL DESIGNS Z W DATE HEALTH AGENT EAST SANDWICH . MA W ( 508 ) 833— 2177 Z va+..m.`-.ryr`-A.,ew.,v'`a,;,Si,.;,"4 n ^•„"''s.,t< -;e,,,,^+....4> "^r'.r '