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HomeMy WebLinkAbout0169 POND STREET - Health 169 PondStreet Osterville A = 118 - 036 ; i I 4 ° 1 } No. V l Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitatlon for Bispoeal 6pStem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( kComplete System ❑Individual Components Location Address or Lot No.161 PdAfaOwner's Name,Address,and Tel.No. �la� m �vlex QTT Assessor's Map/Parcel / �-03�j /� Installer's Name,Address,and Tel.No. ���63/�S y� Des' ner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms ^d Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 1/TeL L tW_6 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided `33 6 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. y 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 o e nvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo d of eal . Si Dat Application Approved by D 10 Application Disapproved by Date for the following reasons Permit No. �o r a Date Issued ---- - - - --- 1-' - - - -- - - - - - - No. THE.COMMONWEALTH OFIASSACHUS,ETT11 S Entered in computer: Yes PUBLIC HEALTh, DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application f6r�lDl8tlosal 6pstetn Construction Permit - Application for a Permit to Construct ' Repair( Upgrade Abandon ( Com lefe System Individual Components PP ( ) P ( �) 'P�' ( ) f ) � P � Y � P Location Address or Lot No.�rp G� Q Owner's Name,Address,and Tel.No. Assessor's Map/Parcel la—03 fit//LLllm er�lep_ 1 Installer's Name,Address,and Tel.No. t��6 j�-g `7 Designer's Name,Address,and Tel.No. Ile Type of Building: Dwelling No.of Bedrooms ^, Lot Size sq.ft. Garbage Grinder( ) Other Type of Building i J wL'L L E ff No.of Persons 3 Showers( ) Cafeteria( ) A Other Fixtures Design Flow(min.required) �j d gpd Design flow provided 330 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank � Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) { Date last inspected: Agreement: - The undersigned agrees to ensurejhd construction and maintenance of the afore described on-site sewage disposal system in accordance with the r visions of Title S o-t e�Lnvironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Bo i d of ealt i r SiplDate-J1(i(w o Application Approved by DaV ' Application Disapproved by Date for the following reasons Permit No. G` O Date Issued ` THE COMMONWEALTH OF MASSACHUSETTS `. BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CER �'that t e n-site Sewage Disp.sa�ystem Gohstructed( ) Repaired( ) Upgraded( ) Abandoned( )by at '( 61 o has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.aOJ'a dated Installer Designer #bedrooms 3 Approved de ignflow 3 3 / n „ gpd The issuance of this permit shall no e o s ed a guarantee that the system w� function ddesigned.li' Date Inspector P _ r I ----------------- -----ra a------------------------ ---------------------------- ----- t;/------------------------g---'---------- No. 0 © 1 Fee 1 C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal ,pstent Construction Permit Permission is hereby granted to Construct( ) #Repair( c) Upgrade( ) Abandon( ) System located at 6 �{ Y, 0 S - 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. Provided:Construction must be completed within three years of the date of this permit. S Date Approved by J TOWN OF BARNSTABLE LOCATION��p / c7d,,Ia S7_ SEWAGE# o%01 "' VILLAGE OS?Cdei/OG1 e ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. , SEPTIC TANK CAPACIT�Y./. LEACHING FACILITY:(fypej ::P tfr`Z- 1'64 7"7P S (size) Z Z!X A q I NO.OF BEDROOMS 3 OWNER S P�— LItVO4 E,�a°7�. PERMIT DATE: lu we COMPLIANCE DATE: J"u ry C, J qT 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Z0 Feet Private Water Supply Well and Leaching Facility(If any wells exist orr site or within 200 feet of leaching facility) /00 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) ` Feet FURNISHED BY v N +� � � o s � � � v� � � �, � w � � w � ._. � A �C a � � ��� �` ;:: r �; _� 0 Town.of Barn stable P# Department of Regulatory Services �� Public Health Division Date. �p 039. 200 Main Street,Hyannis MA 02601 *• + Date Scheduled Fee Pd. D. Soil Suitability AssessmentfoAr Sewage ios : y Witnessed �, d Performed H ) � By: f� �� � (� LF CATION c& GENER4 IN ORMATIOIX a I Location Address / wner's Name WILLIN41, YOA Address CVei'L -T-r Assessor's Map/Parcel: ` Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(96) 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&pert tests,locate wetlands in proximity to les) o � - !> Parent material(geologic) 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: o -in, Depth to soil mottles., 1n. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level _ Adj,factor m g Ad{,draundwater bevel PERCOLATION TEST Date, Thne..� Observation 's I Hole# Time at h" Depth of Perc a N Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak' } e Rate Min./Inch �H41 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:\SEPTIC�PERCFORM.DOC DEEP.OBSERVATION MOLE LOG hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones,Boulders. �Q G� onsistency.%Oravel) t -Z Cab 1 G � . Ct:=> , DEEP OBSERVATION HOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION DOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) DEEP OBSERVATION DOLE LOG Dole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes _ Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious ma erial exist in all areas observed throughout the area proposed for the soil absorption system? � If not,what is the depth of naturally occurring pervi us material? Ceftification I certify that on q (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with . the required training,exper' e nd rien described in 3 10 CMR 15.017. '2 f Signatur Date Q:\SEPTiC�PERCFORM.DOC f Town Of Barnstable Regulatory Services Thomas F. Geiler,Director iARNSTABLE, s p Public Health Division Thomas McKean,Director 200 lain Street,Hyannis,MA 02601 Office:.508-862-4644. Fax: 508-790-6304 Installer &Designer Certification Form Date: j U r��=—f—=— Designer: t.S�g � `-1 Installer: t �L Address: . `��� � Address: On J'6/we, -7 13 Itl was issued a permit to install a (date) (installer) _ septic system at t/ 7 (, based on a design drawn L�Y (address) �• `'M71,!y4• dated 7TVwt (designer) ,certify that the -septic system referenced above was installed substantially according't€� Idie design,_which may include minor approved-changes such as latexas relocation of the dUtribution box and/or septic tank.. I certify that the septic systerxs referenced above was inst4cd with'MSor.changes'(Le. greater than'10' lateral relocafibn'of the SAS or-any vertical reiooat on of any compon6ut of the.sepT,;system)but in'. n accordance with State&L6cARegiilail6ns. Plan r6,vi ion o certified as­Wj by designer to`follow. Av (Installers ignature) ', 1!a tb66. :: t A-- - 'LULL ...... sgN1TAR�P� (1J er s Signature) ', (Affix er's SAP Here) PLEASE RETURN TO BA T&TAULE PUBLIC REALTR DIYISI0N.-, C RTMC . TE OF-• C2IV DANCE. =r'NMS = SSUED .BOT$=T13 F R BUILT CAS ARE RECEIVED B iTHE.B t LIABLE PUBLIC kL WW1 SION TIIiANK YQU. f, Q: I-�eaith/Septic/Desib er Certification Fom.; d A s 1 ASSESSUIiS MAP: I NO I LS: PARCEL: TEST �-i o L c L o G s �lp _ '� I. SU I L EVAL"Al Uhl : W I I he iuslallation shall comply�I with'l itle V find 7 own of� 1)uaid v( � ___._.Y...___ REFERENCE: WITNESS : IDOWWA _ 1 y� ?� —DATE.- MAA 0 llealtli Regulations. ZOD 2) 'I'lie installer shall verily line location of utilities, sewer iiver(s and septic `T..J - components prior to installation and setting; base elevations. PEKCULAT 1 ill RAJ E: A. D 3) All gravity septic piping to be 4 inch Sell 40 PVC at 1/8" per loot. The first two lest out of the d-box to the leaching shall be level. 11-1-2 4) 'plus plan is not to be utilized for property line determivatiou rtor any other ' n purpose other than the proposed system installation. LD Xf ZJ „� � 5) All septic components must uieet'l'itle V specifications. t� I� 6) I'arkiug shall not be constructed over 1110 septic compornents. l r v' 7) The property is bounded by properly corners and property lines. LOCA 1 1014 NIAl t �7 10 Lj 8) 'I'lie property owner sl►all review design cunsiderations to approve of total Z design Jlow and number of bedrooms to be considered fur design. Receipt iJl�tt� - � ,LJ ►J of payment Ior the plan and installation based oil the plau shall be deemed approval of the design glow by the owner. /k,_ C, Z v ✓ 9) The existing leaching or cesspools shall be pumped and billed with material ' I per'fitle V abandonment procedures. Those within the proposed SAS shall 1 1 p' p` be removed along with contaminated soil and replaced with clean sand per 'bilge V s mcs. WHOlU)Systenn componeals to be lU feet lioiu water line. Sewer lines crossing the , ,-� water line shall be sleeved with 4 such SCl 140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service --- ' line. 'I'he line is to be sleeved as albrennenlioned aid maintained in place.----�� S I_h _I I C S Y S I�L M D C S I C N 11) If a garbage grinder exists it is to be removed aid is the responsibility of the owner to ensure such. FLOW ESTIMATE 12)'fhe installer is to lake caution in excavation around the gas line il'such 2>j y exists. BEDROOMS AT 110 (3AL/UAY/UEUIiUUfd -??� GAL/UAY �13)Tlie installer slnalLveril'y the location, quantily and elevation of the sewer i / lines exiling the dwelling j�rior to line installation. SEPTIC TANK 14)'I'his plan is representative only that a system call lit on a property nnecling / Title V requirennents. GAL/DAY x 2 DAYS - 19D GAL qb'g ({SE ("vW GALLUW SEP,T C TANK ( � `1' l.."lsliu-'Y Sj+ W�II/�C/ � •II.Jd.���!'�� ���{OF ly]gs��'�.� ' `Slit L A sO1tI'' 1 UIJ SYSTEhd �P sq�� � DAV{D - MASUv = O f S SEPTIC S-Y�STEM.' SECT ION b6 _b TOlk"A I ` �► , \07 �=E3� (;AL �Z. I13XL� SEPTIC TANK L4 7� ._- _ S I 'I-L AMID 50 L- P LAN 0�-1 --- LOCAT I ON : V4P ru - 1 /tH � �L .1 ►y �lol l?�i.►Z Pbt/L HIL--PARED FOR :14 �I M ORE S CALL: DAY I D 1--3 . MASON It , 5 UA f E a t DBC ENV I BONIvIEN FAL DES 1 c;IJS I::AST SANDWICH . MA UAJ E IIEAL11I AGEIJI' r ( 508 ) 833- 2177