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HomeMy WebLinkAbout0114 SEAPUIT ROAD - Health 114 SEAPUIT ROAD, OSTERVILLE A=146-112.002 LOT 146 Y o� No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH ccl o F /J APPLICATION FOR DISPOSAL SYSTEM CONSTRUC ON PERMIT Application fore a Permit/to Construct ( Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System Individual Components Locatio Owner's Name S a" i M•p/P reel# / ^-� r Address of It Telephone# Ins Iler's Name Designer's a e I /V!2 Address 17 Address Telephone# Telephone# Type of Building: Lot Size /) -, `7 3 7 Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. equired) SSO gpd Calculated design flow SSA gpd Design flow provided S33 gpd Plan: Date 7- 'LG Number of sheets I— Revision Date 1-1 1-4 Title Jc -f <-n-,-/ al:--- .-0� Description of Soil(s) jee OP(�.. Soil Evaluator Form No. Name of oil Evaluator © Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further ag ro place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date ^ / 161 O FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 TOWN OF BARNSTABLE LOCATION Al GC S���`' �- V?J SEWAGE # 1 �� VILLAGE &<-q V ASSESSOR'S MAP& LOT }} INSTALLER'S NAME&PHONE NO. l SEPTIC TANK CAPACITY �® LEACHING FACILITY: (type) -D LV L✓Ot t S (size) NO.OF BEDROOMS BUILDER OR OWNER -J-°Y C C_ 0 l PERMIT DATE: 3 ( t �' `� COMPLIANCE DATE: Q 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 - t ,t:: .�. � �� �� , ,� .. 4� �I I� �� ���� I � � � �-P . � � '<� 1� .�� � � - � - � r � �® 9 _ .,t TOWN OF BARNSTABLE SEWAGE# 1 w - I i Z, LOCH.. &LOT ¢y✓;I(e �/y ASSESSOR'S MAP o o Z VILLAGE,: INSTALLER'S NAME&PHONE NSo SEPTIC.TANK CAPACITY So LEACT3ING FACILITY: (type) 11 S (size) NO OF BEDROOMS �a ri.o� �e BUILDER OR OWNER 6 q e 6/S d COMPLIANCE DATE: PERMIT DATE: i A Sep Between Between the: Feet Leachin Facility Table to the Bottom of g Maxiriuni.Ad�usted Groundwater Ta an wells exist 1 Well and Leaching Facility (If Y Feet .Private Water SuPP y on.-thee or wi etlands ex thin 200 feet of leaching facili tywist Feet e bf'Wedand and Leaching Facility(If anY Edg.::: :. ihiii 300 feet of leaching facility) Furnished by . f~ °!•' /� �� ram_ 0 PS _. .,.�.. 00 No. THE COMMONWEALTH OF MASSACHUSETTS FEE t7l�� ., BOARD OF HEALTH cv✓? o F APPLICATION FOR DISPOSAL SYSTEM CONSTRUC ON PERMIT Applicati9n for:a'PScrmit to Construct (� Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System Individual Components �� - Location Owncrs Name M tp/Pe reel N Address Al- / _7 Lot,7 Telephone# / O r✓ mac. h L G•rii. Ins ller's Name Designers Na e -104 a Address Address 3 4 r— Telephone U - Telephone#� r ` j Type of Building: `if6S dam•�e L Lot Size �s� y 3 7 Sq.feet �• Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other'fixtures t . ' Design Flow(mixll: equired) ��19 gpd Calculated design flow S-Ya gpd Design flow provided S S3-gpd Plan: Date "J t6 Number of sheets Revision Date Title 5 4 E s.e.✓ � .e o s /rf a ,.f.�.ir �� �S��: Description of Soil(s) 9(4-t— Soil Evaluator Form No. Name of Soil Evaluator ® Date of Evaluation S 2 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of i TITLE 5 and further agr s to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. OFFSigned j Date s° f t 1 'f • ,..mow ,. FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 S No. y/ Y THE COMMONWEALTH OF MASSACHUSETTS FEE Oaro-r-) BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) by: )r r 'f at �'�` Swat has been installed in.,accordance ith the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. i �" dated "A e• ./ ! Approved Design Flow (gpd) Installer ',-f Designer: i�,i` Inspector Date l� The issuance of this c tificate shall not be construed as a gu r ntee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby, granted to Construct ( �)S epair ( ) Upgrade ( , ) Abandon ( ) an individual sewage disposal system at �� 56100U(!�d �J k,/'Udbj, as described in the application for Disposal System Construction Permit No. dated. N Provided:.'Construction shall be completed within three years of the date of this per 't.All local condition! ust be met. Date '" '� Board of Hpalth� " FORM 2 - DSCP DEP APPROVED FORM 5/96 HOBBSB WARREN FORM 1255 (REV 5/96) H&W rM PUBLISHERS- BOSTON W V Town of Barnstable �n!�rf # 9 Department of Health,Safety,and Environmental Services Public Health Division Date y5w- —� 367 Main Street,Hyannis MA 02601 II eAnrtMerE • , Musa 039.0r Date Scheduled '� 2 Time Fee Pd. FD Mfd �_ ^� Soil Suitability Assessment for`Sewage Disposal � ; Performed By: Witnessed By: LOCATION &;GENERAL INFORMATION 6 ... � �, �, !�. • Owner's Name Joyc e- ►�l(S0 Location Address / .,.� f DYI Address o 97,41 Assessor's Map/Parcel: j1/� I' ,J / L� �2 t/r ) Engineer's Name NEW CONSTRUCTION REPAIR .Telephone# Land Use Q!O a.' Slopes(%) Surface Stones �V N Distances from: Open Water Body N6 N f ft Possible Wet Area'Nb Mt,- ft Drinking Water Well P7 ` ft -- Drainage Way 1V�N ft Pr`operty'Line ���ft Other s k,�It SKETCH:(Street name,dimensions of lot, locate s of test holes&perc tests,locate wetlands in proximity to holes) �J r �/ 'ot z w �G l,�} 14�6 �t � - • • o UlJ Rp 3os Parent material(geologic) Lak Oeu( y Depth to Bedrock Depth to Groundwater: Standing Water in Hole: No N f Weeping from Pit Face ✓� Estimated Seasonal High.Groundwater Dr,i Milt 111�(H i i0�i' O t':'L 'S NT AJj Method Used: N�1� uo...t�,l�t•�2 o$.5; �.P 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 PERCOLATION TEST' Date Time 1';P/►1 Observation l�7 Hole# Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak /� Rate Min./Inch L�e.4'f� " z a►r iti1jNGk. W MA S44o� G Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be.Completed on Back-� Copy: Applicant 1 ` DEEP:OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,o Z-- o Looms .,( /Gyi2y 3 �- �-3G L - 36 ., .. .. "`DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horiwnk Soil Texture Soil Color I• Soil' ,I Other Surface(in.) (USDA) ` (iounsw1) MoLdiug (Structure,Stones,Boulderes. Consistena.° Gravel) 11—U (17 Go�u of log ,; •t t, , , 36-E2O G 5a4d Z, IL DEEP DEEP OBSERVATION HOLE LOG x .. ,. „� Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistencv.° Gravel) A� DEEP:OBSERVATION HOLE LOG Ho1e# ' Depth from Soil Horizon Soil Texture : Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° Gravel) . t Flood Insurance Rate Map: Y Above 500 year flood boundary No— Yes ' Within 500 year boundary No_ Yes is,• Within 100 year flood boundary No_ Yes , Depth of Naturally Occurring 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? �__ If not,what is the depth of naturally occurring pervious material? Certification I certify that on e.CA (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 training,expertise and ex erience described in 310 CMR 15.017. Signature�^'�` �` _ Date 5 2v l %. T.O.F. AT EL. ;i.o SEPTIC PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN O' OF FIN. GRADE (NOT TO ACCESS COVER (WATERT10M TO ENGINEER: o-YA- WITHIN Ir OF FIN. GRADE �{'Z� MINIMUM .75 OF COVER OVER PRECAST 0 2% SLOPE REQUIRED OVER SYSTEM WITNESS: 2" DOUGLE WASHED PEASTONE DATE: .S o FOR FIRST 2RUN PIPE L' I , PERC. RATE Vi PROPOSED e¢ MAX. GALLON SEPTIC ?J� .S 9j CLASS , SOILS P# ' 7 TANK (H— 10 ) GAS c oop 0 mc:3c- cp 0 M C3 Cj M 0 0 0 3 C" gi E5 rlaktit ' ( 5 x SLOPE) W CRUSHED STONE OR MECHANICAL C] C� © C1 0 � � C] 0 ELEV. ( ] ELEV. _ COMPACTION. (15.221 [21) 2' m C3 © 1� C C] 0 0 0 I . 11 �`.�j 0,► o �kh� '4iC DEPTH OF FLOW (` % SLOPE) (�7G SLOPE) "— TEE SIZES: 3/4" TO 1 1/2" DOUBLE WASHED STON°' O INLET DEPTH 10 2' � LOCATION MAP SCALE 1" w ?,voo OUTLET DEPTH A FOUNbATiON �� SEPTIC TANK a 2 , - D' 80X 17 LEACHING py g ASSESSORS MAP �s PARCEL, FACILITY ZONING DISTRICT, 9.r I 93 _. ...... YARD ^" S o °f 2 s � �'� I o moo- sw FRONT C�, SIDE REAR ,� S f35 Polk PLAN REF. FLOOD ZONE: i N _L� .�- 1 � 2G,o / 1 1 T �`EPiIC DESIGN: ( olPo!!1'R : _N ( tiWohl��O ) 1. DATUM Is '!'�`�� t�,or�) t°,u� �r'�p.htk_ GrIS *Aa-D B 7I)I;cOO MS "00) - 1550rPD 2. MUNIC PAL WATER IS _ 'v1A-I IAP)t- r USE A '55oGPD DESIGN FLOW s. iuil, NIum . .� "s ' T., . "_' ' /1�" bER - SEPTIC TANK: 550 GPD ( Z ) -- I i o0 4. DESIGN LOADING FOP ALL PRECAST UI�"I''S TO BE � N� 5. PIPE JOINTS To BE MADE WATERTICHT. USE A 15o� CALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH NMS. ENVIRONMENTAL CODE TITLE V. rn SIDES: '(A, S + j O s3 Y z4� - ` 7. THIS PLAN IS FOR PROPOSED WOOX ONLY AND RIOT TO BE USED FOR LOT LINE STAKING. 41 P��ric,�NIA� s In, �y B. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC,''. � - no•atio BOTTOM: `� 83 ( 14.1 Sao. 9. COMPONENTS NOT TO BE BACKF`ILLED OR CONCEALEb WITHOUT TOTAL: �`�� S.F. 55'�• GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED SoO4e.t. . A�rHE. 04- 1EQ FROM, BOARD OF HEALTH. a 1.4&otigon. • r11f 2%: 10. CONTRACTOR SHALL BE REVOINME rM VE'P MNO THE P(zo r s P fz- `�=-� �' � LOCATION OF ALL UNDERGROUND OVERHEAD UTILITIES PRIt"IRI! TO COMMENCEMENT OF WORK. \ � ♦ i -O��e y,e liYVY \a �1 I S TE AND SEWAGE* PLAN 100.0 PROPOSED SPOT ELEMION OF X 4� o x 106x0 Vf"NG SLOT LLEVATION IN THE TOWN OF: 41 PROPOkD CONTOUR �z �/ \ tXI"Nd CONTOUR PREPARED FOR: ' ITT 14ce, SS MAO 6p mail KA r SCALE I'' � DATE: �r✓� ti1o, �q q�APPROVED olk OF o dolt Cape !' 111'i'erlhg, inn. ARNE H. "LA ARNE C1VtL C L LNOTRIM 'tS •�.0 No. N c►S SJ� 3` 3 JOB# �nr >Il. ! ri, 1I11A a✓A .s. DA rS q -1- 1 3 2—