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Home My WebLink About0147 SCUDDER ROAD - Health 147 SCU, DDER ROAD A -� 140 - 012 I I V ' 1 x o fVrvE I E f I 4 I I e R r Town of Barnstable P a of� Department of Regulatory Services BAMSTABLE,: Public Health Division Date Y MAkl saw peg� p 200 Main Street,Hyannis MA 02601 Date Scheduled Time Fee Pd. Soil Suitability Assessilent for Se wa a Disposal Performed By: I ' Witnessed By: b LOCATION&GE RAL INFORMATION Location Address ' �/�1 +,V/�i�A -Owner's Name v Address Assessor's Map/Parcel: I (�O Engineer's Name Y.1 ' NEW CONSTRUCTION REPAIR Telephonei Land Use - Slopes(%) Surface Stones Distances from:.. Open Water Body ft Possible Wet Area ft Drinking Water Well'. It - Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) ys Z 71 L L� 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: - '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 Adj.factor Adj.Groundwater Level yy. PERCOLATION TEST Date Time —.. Observation Hole# j Time at 9" Depth of Perc ✓ Time at 6" - - -- Start Pre-soak Time @ Time(9"-6") _ .. End Pre-soak Rate MinAnch 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 N'^ 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 d� G 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) Y '"AST- / D_EEP 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,%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No //Yes Within 500 year boundary No` xes_ Within 100 year flood boundary No_Y/Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery o a rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of na lly occurring pervious material? _ Certification d I certify that on �o -I (date)I have passed the soil evaluator examination approved by the Department of Enviro en Prot% tion and that the above analysis was performed b me consistent with the required traffiffig.expertise a �-xp�es 15.017. Signature Date Q:\SEPTIC\PERCFORM.DOC TOWN OF BARNSTABLE LOCATION 7 IW, Sc,y(&�er R SEWAGE# d01 3 —100 VILLAGE OS I G )riA ASSESSOR'S MAP&PARCEL cc INSTALLER'S NAME&PHONE NO. Age w.At l� k��'!N�O�5��, �Z-L71 77 SEPTIC TANK CAPACITY ),Soo GAL N -to LEACHING FACILITY:(type) A R G 36 H C, (size) 1-I 1 X )X NO.OF BEDROOMS 3 E cxsr," To. LeS foo 5 OWNER Q&rreK a &rxsom PERMIT DATE: 3/1,C/1013 COMPLIANCE DATE: 3 �3 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 y FURNISHED BY Pos �h= fib► 4 _ L*C 61 �h�4 Cb No. _ u I — /0V THE COMMONWEALTHµ OF MASSACHUSETTS FEE BOARD OF HEALTH I LOV-) OF V APPLICATION FOR DISPC,SAL;SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components OY-ocatwn /Z. O !11 I n�'Fi1LO\wn/�'s Name 12 Map/P cel# / Address "ter k4ei J !,D Teleglfr}ttl# � Address Address Telephone# Telephone# Type of Building: ' I`� Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min requi ed) gpd Calculated design flow_ gpd Design flow provided pd Plan: Date Number of sheets Z Revist n Date Title lZ Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation C_ 3 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described In ividual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a rees not to place the s stem in operatio7juntil a Certificate of Compliance has been i sued by a Board of Health. Signed Date Inspections 0011 FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. o I /11V^ THE COMMONWEALTH OF.MASSACHUSETTS FEE ° y / B1OA'FD OF HEALTH 'OF APPLICATION FOR DISPO,SAYSTEM CONSTRUCTION PERMIT �.r Application for Permit to Construes& ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System ❑Individual Components ocation owner's Name Map/P�(M# Address �--„•� yt A j G+n -a Teleg/hy)#� Z�q �5[55g —Iu��/me C�J l✓1 G —DLJ62 / (O/7 Address Address —� _ Telephone# Telephone# Type of Building— Dwelling—No.of Bedrooms ' Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(*Z0 requi ed) (2 gpd Calculated design flow gpd Design flow provided pd Plan: Date 357 . Number of sheets Revtst n Date Title / Description of Soil(s) tee- - �4-- Soil Evaluator Form No. Name of Soil Evaluator '*�J Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undeirsigned agrees to install the above described In ividual Sewage Disposal System in accordance with the provisions of TIY-,W5 and-further agrees not to place the system in operotio until a Certificate of Compliance has been i sued by a Board of Health. Signed *. �..._� p''f r Date Inspections n 1A CA � FC1.RM t —APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. 3- /00 THE COMMONWEALTH OF MASSACHUSETTS FEE ( rw W5roKf1 BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) Ek ComPlete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ,Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMA 15.00 (Title 5) and the approved design plans/as-built plans.relating to application No. 0 rz--1 U0 dated 312S // 3 Approved Design Flow _(gpd) Installer '',�4 f,'4)� Designer:'� 2/4-11-x � InspectoY, d The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 • I� No. 2.0 ( 3 Up THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCT19ON PERMIT Permission is hereby anted o Construct Re air ( Upgrade (Y) Abandon { an individual sewage disposal system at '�� , as described in the application for Disposal System Construction Permit No. 1c)f 7'- ).UJ dated ?/2-5- / Provided: Const uction shall be completed within three years of the date of this Er pn-1 . 'll local co ditionns must be met. Date / 3 Board of Health 1 �MA �C FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON I I r ! I ' I ' I I ! I ! ! TOW OF E'RN T B E � 1 ! 2Ql3 I' "It 22 RM 2: 15 I ' ! I DI-VI SIO ! I ! 1 1 ! I ! ! ! I I I I 1 1 I 1 I I ! I I 1 ! f I ! I ! I I I I 1 I 1 1 I ' 1 I , , 1 f ! ! ! 1 I I 1 , I , I 1 ( 1 ! � f I ! I ( I I I ! i f ! I f Town of Barnstable BIKE�� Regulatory Services Thomas F. Geiler, Director r r BABNSTABLE. 'Public Health Division MASS. $ �OtEp �A�0 Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508- 62-4644 Fax: 8-790-6304 Date: 2(p Sewage Permit# Assessor's Map/Parcel 14z) Installer &Designer Certification Form Designer: 1 Installer: U0, (fomp �. Address: Address: wm On imp C , was issued a permit to install a ( e) (installer) septic system at ( based on a design drawn by ( address <W LO g dated (designer) Voo, I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system 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 R- '-Lions. Plan revision or certified as-built by designer to follow. Stripout (if rP- "'cted and the soils were found satisfactory. �P-- OF Mgss DAVID qcy � O B. c- (Installer's na MASON � �j ib 9 No.1066 0 ( signer igna re) ` PLEASE RETURN TO BARNSTABLE PUBt..._ ��fE OF COMPLIANCE WILL NOT BE ISSUED UN 11L ISV i H i rin t'uRM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnMesignercertification fonn.doc ASSESSORS MAP : NOT S: TEST HOLE LOPS J PARCEL 12 FLOOD ZONE: /t//jj-' f'r '�/� �` SOIL EVALUATOR:- WITNESS 1 (� 1) The installation shall comply with`Title V and '.i'own of oar o I lealth Regulations. : REFERENCE: 2) The installer shall verily the location ofutilities, sewer inverts and septic 'q � �� DATE: z Zt?) --- - - - - ---- components prior to installation and setting base elevations. ... ---- -- -- PERCOLATION RATE- 2 iMt � - P��/ CJ� - //,3 �7 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. 'Flee first _.. ___.. h�li___.__.._ ____ ________ _ V �'� �;�� ✓ I, 7, two feet out of the d-box to the leaching shall be level. TH-2 4 This plan is not to be utilized for property line determination nor any other �I�UA� �q,l purpose other than the proposed system installation. f( I �� , 4 5) All septic components must meet'l'itle V specifications. 6) Parking shall not be constructed over I I 10 septic components. �I 7 'flee property is bounded b property corners and property lines. 10 9 ) p p Y Y 1? P Y P h Y �,7i 8) The property owner shall review design considerations to approve of total LOCATION MAP 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 n l approval of the design flow by the owner. l.� 9) The existing leaching or cesspools shall be pumped and tilled with material / 1 procedures. Those within the proposed SAS shall per Title V abandonment p p 1 Z 1 be removed along with contaminated soil and replaced with clean sand per `hitle V specs. b 10)System components to be 10 feet from water line. Sewer lines crossing the ,� • G water line shall be sleeved with 4 inch SCI 140',l'VC with ends grouted if applicable. 'fhe proposed SAS is being installed below the water service r ( line. The line is to be sleeved as aforementioned and maintained in place. SEPT IC SYSTEM D E S I G N I 11) If a garbage grinder exists it is to be removed and is the responsibility of the b t �7n owner to ensure such. i 1 Mq , FLOW ESTIMATE MATE � 12)'I'he installer is to take caution in excavation around the gas line if such exists. ' BEDROOMS AT i I GAL/DAY/BEDROOIA -u�GAL/DAY 13)'flie installer slrall,verify the location,quantity : lid elevation of the sewer o lines exiting the dwelling'prior to the installation. SEPTIC TA14K 14)'This plan is representative only that a system can fit on a property meeting I Title V requirements. 20 GAL/DAY x 2 DAYS - "�D GAL Z' USE I ' GALLON SEPTIC TANK SOIL ABSORPTION SYSTEM L ki i �Il A 10 o _ . 1N. � d V hl1T ` ► 4 M V DAVID B. N � SEPTIC SYSTEM ' SECTION �� NO 1066 rot_ -I - __ _ UIl\ 'M D-BUx ;A--- /57CO GAL :4�7= 1-7 II N SEPT I C TANK �-- _ o Z. \ ---�- �- -- S T E AND SEWAGE WAG L P � . .. I _ LAN ILOCATION : *A7 5�►fi�P, -eaPD P R E P A R E D F 0 R : P , .� p � SCALE I %z 0. DAV I D B . MASON S DATE: p zo► z DBC E14V I RONMENITAL DES I GNS EAST SANDWICH . MA W DATE HEALTH AGENT � ( 508 ) 833- 2177 Z